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Insurance chapter 12
Chapter 12 insurance
| Question | Answer |
|---|---|
| an individual becomes eligible for Medicare Parts A and B at age | 65 |
| Medicare Part A is _____________ and Medicare Part B is _____________ coverage | hospital; outpatient |
| Name an eligibility requirement that would allow aliens to recieve Medicare Benefits | an applicant must have lived in the United States for 5 consecutive years |
| funding for the medicare Part A program is obtained from_________ and funding for the medicare part B program is obtained equally from _______________ | special contributors from employees and self employed persons with employer matching contributors; those who sign up for medicare and from federal government |
| Define a Medicare part A hospital benefit period | it begins the day a patient enters a hospital and ends when the patient has not been a bed patient in any hospital or nursing facility for 60 consecutive days |
| a program designed to provide pain relief, symptoms management, and supportive services to terminally ill individuals and their families is known as | hospice |
| short term inpatient medical care for terminally ill individuals to give temporary relief to the caregiver is known as | respite care |
| the frequency of Pap tests for medicare patients is _________ and that for mammograms is ______________ | once every 24 months (low risk) once every 12 months (high risk); once every 12 months |
| Some third party payers offer policies that fall under guidelines by the federal government and may cover prescription costs, Medicare deductibles, and copayments; these secondary or supplemental policies are known as _____________ insurance policies | Medigap and Medifill |
| Name two types of health maintence organization plans that may have Medicare Part B contracts | HMO risk plans & HMO cost plans |
| the federal laws establishing standards of quality control and safety measures in clinical laboratories are known as | Clinical Laboratory Improvement Amendment of 1988 |
| Acceptance of assignment by participating physicians means that he or she agrees to ___________ after the ______ annual deductible has been met | accept payment from Medicare; $135 |
| Dr who schedules an operative procedure in 1 month. this type of surgery is known as ________ becuase it does not have to be performed immediately | elective |
| a medicare claim form showed an alphabetic code, J0540, for an injection of 600,000 U of penicillin G. This number is referred to as a _______________________ | Health Common Procedure Coding System (HCPCS) level 2 code number |
| Organizations or claims processors under contract to the federal gov that handle claims and payments for hospital under Medicare Part A are known as ____& those that process claims for doctors & other suppliers or services under medicare part B are called | fiscal intermediaries; medicare administrative contractors |
| A center for medicare and medicaid services assigned provider identification number is known as a __________ physicians who supply durable medical equipment must have a _________ number | National provider identifier; DME supplier |
| if circumstances make it possible to obtain a signature each time a paper claim is submitted or an electronic claim is transmitted, the medicare patients signature may be obtained either __________ or ____________, thus indicating the signature is on file | on a form created by the medical practice; in block 12 of the CMS-1500 insurance claim form |
| the time limit for sending in a medicare insurance claim is | the end of the calander year after the fiscal year in which services were furnished |
| A medicare/medicaid patient, has a cholecystectomy. In completing the insurance claim form, the assignment portion is left blank in error. What will happen in this case? | only Medicare processing will occur, and the payment checks will go directly to the patient medicaid will not pay |
| if an individual is 65 years of age and is a medicare beneficiary but is working and has a group insurance policy, where is the insurance claim form sent initially? | To the employer sponsored plan |
| If a medicare beneficiary is injured in an automobile accident, the physician submits the claim form to | the automobile liability insurance, no fault insurance, or self insured liability insurance company |
| Medicare prescription drug benefits for individuals who purchase the insurance are available under | Medicare Part D |
| Medicare secondary payer cases may involve | medicare aged workers under group health plans of more than 20 covered employees, medicare aged or diabled individuals who also receive benifits under dept of vet affairs and medicare, medicare patient who involved in a auto accident |
| if a medicare patient is to receive a medical service that may be denied payment either entirely or partially, the provider should | have the patient sign an advance beneficiary notice |
| a decision by a medicare adm contractor whether to cover a particular medical service on a contractor wide basis in accordance with whether it is reasonable and necessary is known as | local coverage determination |
| according to regulations, a medicare patient must be billed for a copayment | at least three times before a balance is adjusted as uncollectible |
| all patients who have medicare health insurance card have Part A hospital and part B Medical coverage | False |
| Prescription drug plans refer to the drugs in their formularied by tier numbers | True |
| Nonparticipating physicians may decide on a case by case basis whether to accept assignment when providing medical services to medicare patients | True |
| Medicares correct coding initiative was implemented by the centers for medicare and medicaid services to eliminate unbundling of CPT codes | True |
| A medicare/ medigap claim is not called a crossover claim | False |
| Mediare Part A | hospital benefits of a nationwide health insurance program for persons age 65 years old and older and certain disabled individuals regardless of income, administered by CMS. Local Social Security offices take applications and supply info about the program |
| Medicare Part B | Medical insurance of a nationwide health insurance program for persons age 65 years old and older and certian disabled induviduals regardless of income, administered by CMS. Local Social Security offices take applications and supply info about the program |
| Medicare Part C | Medicare Plus Choice plans offer a # of health care options in addition to those available under Medicare Part A and Part B. Plans may include health maintence organizations, religious fraternal benefit societies, and medicare medical savings accounts |
| Medicare Part D | Stand alone prescription drug plan, presented by insursuance and other private companies that offer drug coverage that meets the standards established by Medicare |
Created by:
Lea99