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MED112 CODE/BILL
MED112 CH 09 MEDICARE
| Question | Answer |
|---|---|
| MED112 CH 09 SB | |
| The Medicare program is managed by ____. A. Federal Social Security Administration (FSSA) B. Center of Medicare and Social Security Program (CMSSP) C. Centers for Medicare and Medicaid Services (CMS) D. Department of Health Profession Services (DHPS) | C. Centers for Medicare and Medicaid Services (CMS) |
| Individuals age 65 or older who are eligible for Social Security benefits may enroll in Medicare Part ___ without having to pay premiums. A. B B. A C. D D. C | B. A |
| Individuals entitled to Medicare Part A benefits are automatically qualified to enroll in ____. A. Medicare Part B B. Medicaid C. Blue Cross Blue Shield D. Medigap Insurance | A. Medicare Part B |
| When was the Medicare Modernization Act enacted? A. 1985 B. 2003 C. 1996 D. 1997 | B. 2003 |
| What is he federal medical insurance program established in 1965 under Title XVIII of the Social Security Act? A. CHIP B. Medicaid C. Medicare D. TANF | C. Medicare |
| Who issues the Medicare card to Medicare enrollees? A. HHS B. VA C. SSA D. CMS | D. CMS |
| Most people eligible for Medicare Part A do not pay a premium for coverage if they or their spouse has ____ quarters of Medicare-covered employment. A. forty B. twenty C. sixty D. 120 | A. forty |
| Who replaced the Part A fiscal intermediaries and the Part B contractors? A. OIG B. MACs C. HCIN D. HCFA | B. MACs |
| Medicare Part B is also called A. Medicare Choice B. Prescription Drug Coverage C. Supplementary Medical Insurance D. Hospital Insurance | C. Supplementary Medical Insurance |
| Certain preventive services for qualified individuals are covered under Medicare without requiring a ____ and a ____ payment. A. deductible; coinsurance B. premium; deductible C. copayment; premium D. deductible; copayment | A. deductible; coinsurance |
| Select all of the following that would be considered cost sharing by the beneficiary. (MAY BE MORE THAN ONE) A. Deductibles B. Coinsurances C. Benefit limitations D. Consumer plans | A. Deductibles B. Coinsurances |
| Choose all of the following individuals that would be eligible to receive Medicare benefits. A. A person who is sixty-five and has paid FICA taxes for at least forty calendar quarters B. A person who is unemployed and receiving income benefits C. A thirty-year-old person who receives dialysis D. A person who is receiving Social Security disability benefits | A. A person who is sixty-five and has paid FICA taxes for at least forty calendar quarters C. A thirty-year-old person who receives dialysis D. A person who is receiving Social Security disability benefits |
| What benefits are offered under the Medicare Advantage Plus Prescription Drug plan? A. It combines a prescription drug plan with a Medicare Advantage plan. B. It can be used with an Original Medicare Plan. C. It provides only drug coverage. D. It can be used with a Medicare supplement plan. | A. It combines a prescription drug plan with a Medicare Advantage plan. |
| A retired federal employee who is over the age of sixty-five and enrolled in Civil Service Retirement System (CSRS) is eligible for ________. A. CHAMPVA B. Medicare C. Tricare D. Medicaid | B. Medicare |
| Select all of the following areas where changes were made to Medicare as a result of the Medicare Modernization Act. (MAY BE MORE THAN ONE) A. Medicare + Choice plans B. Hospice care benefits C. Better benefits and lower costs for Part C enrollees D. Durable medical equipment benefits | A. Medicare + Choice plans C. Better benefits and lower costs for Part C enrollees |
| Select all of the following services that are excluded under Medicare. (MAY BE MORE THAN ONE) A. Eye refraction B. Acupuncture C. Influenza immunizations D. Self-administered medications | A. Eye refraction D. Self-administered medications |
| What is “step therapy”? A. A plan that requires patients to try a generic or less expensive drug rather than the prescribed medication B. A plan that covers drugs in the inpatient setting and is subject to a monthly premium C. A plan that requires patients to have a Medicare supplemental plan to cover drugs that may be too expensive D. A plan that gives patients access to discounted drug prices | A. A plan that requires patients to try a generic or less expensive drug rather than the prescribed medication |
| Upon enrollment in the Medicare program, providers are issued a(n) ________. A. provider quality review service B. Medicare beneficiary notice C. Medicare provider benefit policy D. provider transaction access number | D. provider transaction access number |
| What is included in a typical MBI? A. Eleven characters using both uppercase and lowercase letters B. Eleven characters using only numbers and uppercase letters C. Eleven digits followed by a numeric or alphanumeric suffix D. Eleven numbers only | B. Eleven characters using only numbers and uppercase letters |
| What is an HPSA? A. A quality reporting program in which physicians or other eligible professionals collect and report their practice data B. A geographic area in which physicians who participate in Medicare receive bonuses C. An online collection of articles that explain all Medicare topics D. A modified per claim payment under the Medicare Physician Fee Schedule based on quality and cost performance | B. A geographic area in which physicians who participate in Medicare receive bonuses |
| Select all of the following claim types that are handled by the DME MACs. (MAY BE MORE THAN ONE) A. Orthotics B. Durable medical equipment C. Prosthetics D. Drugs billed by physicians E. Skilled nursing care | A. Orthotics B. Durable medical equipment C. Prosthetics |
| What are payment arrangements for Medicare PAR providers? A. PAR providers receive 10 percent higher payments than nonPAR providers. B. PAR providers receive incentives for using an EHR. C. PAR providers must estimate how much the service or item will cost Medicare prior to submitting a claim. D. PAR providers must accept the charge amounts listed in the MPFS as the total payment amounts. | D. PAR providers must accept the charge amounts listed in the MPFS as the total payment amounts. |
| Participating providers may bill patients for services that are excluded from the Medicare program with a written notification called a(n) ________. A. exclusion ABN B. RBRVS C. Medicare EOB D. voluntary ABN | D. voluntary ABN |
| What determines the services that are covered under Medicare? A. AMA B. Medical practice C. FDA D. Federal legislation | D. Federal legislation |
| Who completes the Header section of the ABN? A. Beneficiary B. Patient C. Medicare D. Provider | D. Provider |
| What should be appended to CPT/HCPCS codes on Medicare claims when an ABN has been signed? A. Qualifiers B. VBMs C. Modifiers D. HCINs | C. Modifiers |
| MPFS was developed from the ____ system. A. PCS B. PQRS C. RBRVS D. UCR | C. RBRVS |
| NonPAR providers decide whether to accept assignment on a ____ basis. A. claim-by-claim B. quarterly C. bi-annually D. monthly | A. claim-by-claim |
| Which form did the voluntary ABN replace? A. UCR B. VBPM C. NEMB D. HPSA | C. NEMB |
| On the ABN form, blanks A-C make up the ____. A. Signature Box B. Footer C. Header D. Options Box | C. Header |
| What are the most restrictive plans of the Medicare CCP plans? A. PPOs B. SNPs C. HMOs D. POSs | C. HMOs |
| What is the purpose of the PTAN? A. It is used for authentication purposes. B. It is used to determine medical necessity for services. C. It is used by providers for the Medicare Internet-Only Manuals. D. It is used for billing. | A. It is used for authentication purposes. |
| Medicare has created Health Professional Shortage Areas (HPSAs) for ________. (MAY BE MORE THAN ONE) A. primary care professionals B. surgical professionals C. mental health professionals D. emergency medicine professionals | A. primary care professionals C. mental health professionals |
| Under the Medicare limiting charges clause, nonPAR providers may not charge a Medicare patient more than ________ percent of the fee listed in the nonPAR MFS. A. 75 B. 200 C. 95 D. 115 | D. 115 |
| Select all of the following that are elements on the MSN. (MAY BE MORE THAN ONE) A. Beneficiary dashboard B. Helpful tips on how to receive an MSN and resources for information C. Medicare requirements for provider renewals D. Claims information detailing the services provided and charges | A. Beneficiary dashboard B. Helpful tips on how to receive an MSN and resources for information D. Claims information detailing the services provided and charges |
| What do ABN modifiers indicate? (MAY BE MORE THAN ONE) A. Which CPT codes require additional information B. Whether an ABN is on file C. Whether services are considered medically necessary D. Whether services were paid by the patient | B. Whether an ABN is on file C. Whether services are considered medically necessary |
| Which of the following services are covered under Medicare Advantage Plans but are not covered under the Medicare Original Plan? (MAY BE MORE THAN ONE) A. Dental B. Custodial care C. Hearing D. Vision | A. Dental C. Hearing D. Vision |
| How much are providers paid by Medicare who elect not to participate in the Medicare program but who accept assignment on a claim? A. 10 percent less than PAR providers B. 5 percent less than PAR providers C. 85 percent of the MPFS D. 50 percent of the MPFS | B. 5 percent less than PAR providers |
| Which former form does the MSN replace? A. HPSA B. EOMB C. NCD D. VBPM | B. EOMB |
| When are CCI updates issued? A. Quarterly B. Biannually C. Monthly D. Annually | A. Quarterly |
| Participating providers may bill patients for services that are excluded from the Medicare program with a written notification called a(n) ________. A. voluntary ABN B. exclusion ABN C. RBRVS D. Medicare EOB | A. voluntary ABN |
| What are nonPAR physicians subjected to under the Medicare payment guidelines? A. RVUs allocation B. UCR practices C. R&C percentages D. Limiting charges | D. Limiting charges |
| Who operates the Medicare private fee-for-service plan? A. HMO managed care companies B. Private contracted insurance companies C. RFB providers D. State-funded health plans | B. Private contracted insurance companies |
| What does the Medical Savings Account pay for under the Medicare Advantage plan? A. Deductibles for Medicare Part D B. Premiums for supplemental insurance coverage C. Expenses for covered services D. Services not covered under Part C | C. Expenses for covered services |
| A(n) ________ is responsible for providing all Medicare-covered services except hospice care in return for predetermined capitated payment. A. AHA B. FSA C. CMS D. MAO | D. MAO |
| Select all of the following gaps that are paid by Medigap plans. (MAY BE MORE THAN ONE) A. Deductibles B. Coinsurances C. Premiums D. All noncovered services | A. Deductibles B. Coinsurances |
| Who runs many of the Medicare CCPs? A. Small private payers that provide private coverage B. State-funded health plans C. CMS D. Major payers that offer commercial coverage | D. Major payers that offer commercial coverage |
| A(n) ________ plan is a plan an individual may receive when retiring from a company. A. supplemental insurance B. medical savings C. individual D. Medigap | A. supplemental insurance |
| Under a Medicare private fee-for-service plan, patients receive services from ________. A. providers in the HMO B. RFB-approved providers C. participating providers in the POS D. Medicare-approved providers | D. Medicare-approved providers |
| In 2010, Medicare stopped paying for all consultation CPT codes from the ________ section except for G-codes. A. Medicine B. E/M C. Laboratory D. Surgical | B. E/M |
| ____ created a new plan for Medicare called a Medical Savings Account. A. HIPAA B. HPSA C. MMA D. FERPA | C. MMA |
| Medicare requires the use of the ____ for coding services. A. DSM-IV B. CCIs C. HCPCS D. ICOs | C. HCPCS |
| Which federal legislation changed the timely filing period for Medicare Part B claims? A. Medicare Modernization Act B. Social Security Act C. Affordable Care Act D. Health Insurance Portability and Accountability Act | C. Affordable Care Act |
| ________ are private insurance plans that beneficiaries may purchase to cover the unpaid amounts in Medicare coverage. A. Medical spending accounts B. Medigap plans C. Medicare Advantage plans D. Religious fraternal plans | B. Medigap plans |
| What is the purpose of the Medicare Integrity Program? A. To identify and address fraud, waste, and abuse B. To ensure quality of care and patient safety for Medicare beneficiaries C. To extend drug benefits to Medicare beneficiaries D. To enable beneficiaries to elect insurance coverage from managed care plans | A. To identify and address fraud, waste, and abuse |
| What type of benefits do supplemental insurance plans provide? A. Benefits similar to those offered under Medicare Part B B. Benefits similar to those offered by MSAs C. Benefits similar to those offered in the employer’s standard group health plan D. Benefits similar to those offered under Medicare Part A | C. Benefits similar to those offered in the employer’s standard group health plan |
| According to Medicare guidelines, what should a provider do if a claim has not been paid after thirty days? A. Contact the payer using the telephone or electronic claim status inquiry. B. Send a second claim to the payer. C. File a complaint to the Department of Insurance for an unpaid claim. D. Send a claim to the patient for payment. | A. Contact the payer using the telephone or electronic claim status inquiry. |
| What should practices do if covered and noncovered services are performed for a patient on the same date? A. Charge the patient instead of the insurance company. B. Duplicate the bill. C. Split the bill. D. Send two claims. | C. Split the bill. |
| Which modifier does the principal physician of record use with the E/M code when billed? A. GX B. PP C. AG D. AI | D. AI |
| According to Medicare regulations, lab work may be performed at which of the following locations? (MAY BE MORE THAN ONE) A. Ambulatory surgery centers B. Off-site labs C. Urgent care facilities D. Physician’s offices | B. Off-site labs D. Physician’s offices |
| What is the timely filing period for claims for Part B providers under the Affordable Care Act? A. No later than the end of the calendar year in which the service was furnished B. Within one calendar year after the date of service C. No later than 180 days from the date in which the service was furnished D. No later than the end of the calendar year following the year in which the service was furnished | B. Within one calendar year after the date of service |
| As a result of Medicare issuing about ________ in payments per year with significant amounts of improper payments, the Medicare Integrity Program was enacted. A. $5 billion B. $500 billion C. $3 trillion D. $100 million | B. $500 billion |
| Medicare defines ________ as those sent to one or more Medicare contractors from the same provider for the same beneficiary, the same service, and the same date of service. A. duplicate claims B. tracers C. coordination of benefits D. reciprocal billing | A. duplicate claims |
| Select from the following the medical staff members that perform incident-to services. (MAY BE MORE THAN ONE) A. Nurse-practitioners B. Radiology technicians C. Physical therapists D. Physician assistants | A. Nurse-practitioners D. Physician assistants |
| Under what conditions should practices split the bill when preparing claims? A. When covered and noncovered services are both performed for a patient on the same day B. When covered and noncovered services are both performed for a patient on different days C. When patients are unable to pay their copayments D. When a service that involves anesthesia is used | A. When covered and noncovered services are both performed for a patient on the same day |
| What is the name of a simplified billing process for vaccines? A. Global billing B. Roster billing C. Incident billing D. Block billing | B. Roster billing |
| All lab work for Medicare patients is regulated by ________ rules. A. Food and Drug Administration B. Laboratory Accreditation Bureau C. Clinical Laboratory Improvement Amendments D. Health and Human Services | C. Clinical Laboratory Improvement Amendments |
| Which mandates electronic billing for physician practices with the exception of offices with fewer than ten full-time employees? A. HIPAA B. OIG C. NCQA D. HHS | A. HIPAA |
| What does the Medicare assignment code C indicate? A. Assigned B. Not assigned C. Patient refuses to assign benefits D. Assignment accepted on clinical lab services only | B. Not assigned |
| If a patient is covered by Medicare and Medigap plan, Medicare will ________ send claim to Medigap for secondary payment. A. secondarily B. temporarily C. automatically D. not | C. automatically |
| Services of allied health professionals provided under the physician’s direct supervision that may be billed under Medicare are called ________. A. balance billings B. incident-to services C. waived services D. global services | B. incident-to services |
| Select all the following statements that are true about roster billing. (MAY BE MORE THAN ONE) A. Vaccinations related to travel are covered by Medicare. B. Vaccinations for influenza and pneumococcal are covered by Medicare. C. The claims do not have to be sent electronically. D. Annual Part B deductibles do not apply to these services. | B. Vaccinations for influenza and pneumococcal are covered by Medicare. C. The claims do not have to be sent electronically. D. Annual Part B deductibles do not apply to these services. |
| Select all of the following that are true of paper claims. (MAY BE MORE THAN ONE) A. The use of signature stamps is acceptable under CMS. B. By law, paper claims must be held longer than HIPAA-compliant electronic claims before payment can be released. C. The use of paper claims slows cash flow. D. Paper claims cannot be paid before the twenty-ninth day after receipt of the claim. | B. By law, paper claims must be held longer than HIPAA-compliant electronic claims before payment can be released. C. The use of paper claims slows cash flow. D. Paper claims cannot be paid before the twenty-ninth day after receipt of the claim. |
| The Medicare assignment code ________ indicates the provider accepts Medicare assignment on clinical lab services only. A. C B. B C. P D. A | B. B |
| If a patient is covered by Medicare and a Medigap plan, how many claims are sent to Medicare? A. three B. two C. none D. one | D. one |
| A form given to patients when the practice thinks that a service to be provided will not be considered medically necessary or reasonable by Medicare | ABN |
| Medicare Part A/Part B administrator | MAC |
| A group of insurance plans offered under Medicare Part B intended to provide beneficiaries with a wider selection of plans | Medicare Advantage |
| A type of federally regulated insurance plan that provides coverage in addition to Medicare Part B | Medigap |
| Nonparticipating physicians cannot charge more than 115 percent of the Medicare Fee Schedule on unassigned claims | limiting charge |
| An organization that previously handled hospital and long-term-care facility claims; now called a MAC | fiscal intermediary |
| Two-track value-based reimbursement system designed to incentivize high quality of care | QPP |
| Providing care remotely using technology | telehealth |
| Emergency treatment needed by a managed care patient while traveling outside the plan’s network area | urgently needed care |
| A document furnished to Medicare beneficiaries by the Medicare program that lists the services they received and the payments the program made for them | MSN |
| Law with a number of Medicare changes, including a prescription drug benefit | Medicare Modernization Act |
| Medicare Part A covers A. MACs. B. hospital services. C. physician services. D. prescription drugs. | B. hospital services. |
| The Original Medicare Plan requires a premium, a deductible, and A. supplemental insurance. B. HIPAA TCS. C. Medigap. D. coinsurance. | D. coinsurance. |
| Determine which of the following individuals is not eligible for coverage under Medicare without paying a premium. A. the husband of a retired CSRS employee B. an individual who has been receiving Social Security disability benefits for four years C. a retired woman with ESRD D. a seventy-year-old man who has paid FICA taxes for twenty calendar quarters | D. a seventy-year-old man who has paid FICA taxes for twenty calendar quarters |
| Which modifier indicates that a signed ABN is on file? A. GA B. GZ C. AB D. GY | A. GA |
| Under Medicare’s global surgical package regulations, a physician may bill separately for A. supplies used during the surgical procedure. B. the removal of tubes, sutures, or catheters. C. diagnostic tests required to determine the need for surgery. D. procedures performed after the surgery to minimize pain. | C. diagnostic tests required to determine the need for surgery. |
| On claims, CMS will not accept signatures that A. are handwritten. B. use signature stamps. C. are electronic. D. use facsimiles of original written/electronic signatures. | B. use signature stamps. |
| Under Medicare Advantage, a PPO ______an HMO. A. is less restrictive than B. has the same network as C. is more restrictive than D. has the same deductible as | A. is less restrictive than |
| Under the Medicare Part B traditional fee-for-service plan, Medicare pays ____ percent of the allowed charges. A. 90 B. 80 C. 75 D. 100 | B. 80 |
| Medicare Part D covers A. prescription drugs. B. none of these. C. screening for cancer. D. mammography. | A. prescription drugs. |
| Medicare medical review is conducted by A. the primary payer. B. the physician. C. the MAC. D. the ADR. | C. the MAC. |
| Means “waiver of liability statement issued as required by payer policy”; used only when a mandatory ABN was issued for a service. | GA |
| Means “notice of liability issued, voluntary under payer policy”; the modifier for voluntary ABNs. | GX |
| Means that the provider considers the service excluded and did not complete an ABN, as none was required. | GY |
| Means that the provider believes a service will be denied as not medically necessary but does not have an ABN due to circumstances. | GZ |
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