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step by step test 1
step by step test review ch 1
| Question | Answer |
|---|---|
| what 2 groups of persons were added to those eligible for medicare benefits after the initial estab of medicare | disabiltiy benefits from sss and individuals with terminally renal failure |
| to what governement org did the sec of the dhhs delegate the responsibility for administrating the med program | cms - centers for medicare and medicade ser |
| what government organiztion handles the funds for the medicare program | ss |
| there are 3 items that medicare beneficaries are responsible for paybefore medicare will begin to pay for services. they are | deductible, premiums and co-insurance no covered by services |
| medicare publishes the medicare fee schedule and usually pays what percentage of the amounts indicated for services | 80 |
| the 3 components of work, overhead (practice expense0 AND malpractice are party of an rvu which means | relative value unit |
| according to the filing guidelines providers must file claims for their medicare pt w/in | 12 months of the date of service |
| what editions of the federal register would the outpt facilities be interested | nov, and dec |
| under what act was a major change in medicare in 1989 made possible | omnibus budget reconliation act |
| can physician charge a pt to complete a medicare form | no |
| individuals covered under medicare are termed | beneficiiaries |
| the ? do the paperwork for medicare and are usually ins co, that have bid for a contract with cms to handle the medicare program for a specific area | medicare administrative contractors |
| medicare part c is also know as | medicare advanatage |
| hipaa stands for | health insurance partability and accountability act |
| the most major change to the health care industry as a result of hipaa was a result of what portion of the act | administrative simplificity |
| the transfer of electronic documentation is accomplished through the ? interchange technology | Electronic data (EDI) |
| the number that is assigned to all providers as aa result of hipaa | national provider identification NPI |
| Under the relative value systerm, ? values are assigned to each service and are determined on the basis of the res necessary to the phy performance of the ser | unit |
| the ? charge historically was specific for each phy but in 1993 the charge for a ser was the same for all phy w/in a locality regardless of the specialty | limiting |
| for co=surgeons, medicare pays ? of the global fee, dividing the payment =ly between the 2 surgeons | 125% |
| specific regulations for medicare are contained in the ? manual | internet only |
| w/i an hmo, there is usually an ind who has been assigned to monitor the services provided to the pt both inside the facility and outside the facility know as | gatekeeper |
| in this model of hmo the hmo contracts with the physician to provide the service at a set fee. this org is known as | individual practice association |
| an all inclusive care program for the elderly that provides a comprehensive package of services that permits the client to continue to live at home is known as | PACE - Program all inclusive care for the elderly |
| in this model of hmo the hom directly employs the physicians ? model | Staff model |
| ? or ? is the largest third party payer in the us | government or medicare, or cms center for medicare or medicaid services |
| an ? ? ? or ? ? , usually an insurance company handles the daily operations for medicare, including paperwork claims payments | MAC - medicare administrative contractors or fisical intermediaries (part a) |
| the ? is the fastest growing segment of the population | elderly or under 19 yrs of age |
| ? assingment is when a provider is when a provider does not bill the patient for the difference between the services cost and medicare allowed | accepting |
| medicare ? is prescription drug benefit | D |
| which group does the medicare program not cover? A. PEOPLE ELIGIBLE FOR DISABILITY BENEFITS UNDER ss b. prisoners c. people with permanent kidney failure | b. prisoners |
| in which issue of the federal register are updates to medicare outpatient reimbursement not published | Oct - hospitals |
| which is not a component that is taken into account with a relative value unit (rvu) a. overhead b. work c. all components d. alpractice | c all are |
| which of the following is an example of a discount that would be permitted as a safe harbor from fraud and abuse REGULATIONS? | B. an hmo contracts with a laboratory for all laboratory services and receives a discounted price |
| medicare program was established in 1965 with the passage of the | ss act |
| physicians, hospitals, and other suppliers that furnish care or supplies to medicare patients are termed | providers |
| ? means that the provider will accept what medicare allows and not bill the patient the difference | accepting assignments |
| hospitals report service from ? services by using icd 9cm codes and the ms-drg assignment | part a |
| the ? is the largest 3rd pary payer in the nations | government, medicare |
| medicare prescitpion drug plan is part | d |
| unit value assigned to each service is | rvu |
| a health care program in which the patient is assigned a primary care physician who is the gatekeeper | hmo |
| covers physician service part ? | b |
| national dollar amount that is applied to all services paid on the medicare fee schedule basis | cf |
| what edition of the federal register would outpatient facilities be especially interested in? | nov and dec |
| what is the largest 3rd party payer | american government |
| what government organization is responsible for administering the medicare program | centers for medicare and medicaid services - cms |
| what are the 3 items that the medicare beneficiaries are responsible to pay before medicare will begin to pay for services | decudtibles, premiums, and coninsurance |
| medicare funds are collected by | ss administration |
| cms handles the daily operation of the medicare program through the use of ? ? ? formerly fiscal intermediaries and medicare carriers | medicare administrative contractors |
| which of the following is not a stated goal of the physician payment reform | not - limit provider liabilities is - decrease medicare expenditures, assure quality health care at a reasonable cost, redistribute phy pymnt more equitability |
| if a participating provider renders a covered ser that cost 100 and bills medicare for the ser and medic allows 58 the provider would write off | 42 (provider bill pt 20% OF THE 58) |
| A PARTICIPATING PROVIDER RECEIVES ?% HIGHER FEE SCHEDULE THAN THE NON provider | 5% |
| what medicare parts covers the following 1. hospic care 2. prescription drug 3. phys visit 4. automatic coverage when 65 | 1. A 2. D 3. B 4. A |
| the mecdicare pres drug, improvement and modernization act 2003 established this new benefit available under the medicare program | part d |
| program is aka as medicare advantage | part c |
| ? are activities involving the transfer of health care info and ? means the movement of electronic data between 2 entities and the tech that supports the transfer | Transaction, transmission |
| under the relative value unit system ? values are assinged to each service and are determined on the basis of the resources necessary to the physician per of ser | unit |
| the ? charge historically was specific for each physician but in 1009 the charge for a service was the same for all phy w/in a locality, regardless of the specialty | limit |
| for co-surgeons medicare pays ? % of the global fee dividing the payment equally between 2 surgeons | 125% |
| specific regulations for medicare are contained in the ? manual | internet-only |
| w/in hmo there is usuallly an individual who has been assigned to monitor the ser provided to the patient both inside the facility and outside the facility. this person is known as the ? | gatekeeper |
| in this model of hmo the hmo directly employs the physician ? model | staff |
| in this model of hmo the hom contracts with the physician to provide the service at a set fee ? associations | individual practice |
| the ? ? contractors do the paperwork for medicare and are usually ins co that have bid for a contract with cms to handle medicare program for a specific area | medicare administrative contractors |
| hipaa stands for | health insurance protability and accountiablilty act |
Created by:
mary t