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meas 137
chapter 9
| Question | Answer |
|---|---|
| hat benefits are offered under the Medicare Advantage Plus Prescription Drug plan? | It combines a prescription drug plan with a Medicare Advantage plan. |
| The Medicare Modernization Act required Medicare to replace the Part A fiscal intermediaries and Part B contractors with Blank | MACs |
| Most people eligible for Medicare Part A do not pay a premium for coverage if they or their spouse has Blank______ quarters of Medicare-covered employment. | forty |
| What is included in a typical MBI? | Eleven characters using only numbers and uppercase letters |
| Select all of the following areas where changes were made to Medicare as a result of the Medicare Modernization Act. | Medicare + Choice plans Better benefits and lower costs for Part C enrollees |
| Select all of the following claim types that are handled by the DME MACs. | Prosthetics Orthotics Durable medical equipment |
| Certain preventive services for qualified individuals are covered under Medicare without requiring a Blank______ and a Blank______ payment. | deductible and coinsurance |
| Most providers participate in QPP through the Blank______ track. | MIPS |
| What determines the services that are covered under Medicare? | Federal legislation |
| outline the conditions under which a service is paid by CMS. | NCDs( national coverage determination. |
| What is an HPSA?( health professional shortage area | A geographic area in which physicians who participate in Medicare receive bonuses |
| Select all of the following that would be considered cost sharing by the beneficiary. | Coinsurances Deductibles |
| Participating providers may bill patients for services that are excluded from the Medicare program with a written notification called a(n) | voluntary ABN |
| What are payment arrangements for Medicare PAR providers? | PAR providers must accept the charge amounts listed in the MPFS as the total payment amounts. |
| Which form did the voluntary ABN replace? | NEMB(notice of exclusion from Medicare benefits) |
| Under the Medicare limiting charges clause, nonPAR providers may not charge a Medicare patient more than Blank______ percent of the fee listed in the nonPAR MFS. | 115 |
| Select all of the following that are types of plans offered under Medicare Advantage. | Medicare private fee-for-service plans Medicare coordinated care plans Medical Savings Accounts |
| Who operates the Medicare private fee-for service plan? | Private contracted insurance companies |
| created a new plan for Medicare called a Medical Savings Account. | Medicare modernization act |
| gaps that are paid by Medigap plans. | Deductibles Coinsurances and payment for some noncovered services |
| What percentage of all Medicare beneficiaries are enrolled in group managed care plans called Medicare Advantage and Medicare Part C? | 70 |
| What type of benefits do supplemental insurance plans provide? | Benefits similar to those offered in the employer's standard group health plan |
| Select all of the following that are Medicare coordinated care plans. | POSs PPOs HMOs |
| Under a Medicare private fee-for service plan, patients receive services from Blank__ | Medicare-approved providers |
| are private insurance plans that beneficiaries may purchase to cover the unpaid amounts in Medicare coverage. | medigap |
| A(n) Blank______ plan is a plan an individual may receive when retiring from a company. | supplemental insurance |
| Which federal legislation changed the timely filing period for Medicare Part B claims? | Affordable Care Act |
| What is the purpose of the Medicare Integrity Program? | To identify and address fraud, waste, and abuse |
| Under the Medical Review Program, who audits claim data on an ongoing basis to check for inappropriate billing? | MACs |
| Services of allied health professionals provided under the physician's direct supervision that may be billed under Medicare are called Blank_ | incident-to services |
| All lab work for Medicare patients is regulated by Blank______ rules. | Clinical Laboratory Improvement Amendments |
| What is the name of a simplified billing process for vaccines? | Roster billing |
Created by:
mwaciba