THEORY TEST
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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| Part _____ of Medicare helps pay for physician and outpatient charges. | B
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| A private insurance company that serves as the federal government’s agent in the administration of the Medicare program, including the payment of claims, is a | Medicare administrative contractor
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| Medicaid allows private individuals (or their families) to deplete their finances to the point where the individual or family becomes eligible for Medicaid assistance. This is called | spend down
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| Fees that Medicare permits for a particular procedure, service, or supply are called | allowable fees
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| Medically needy individuals can reduce their assets to the Medicaid eligibility level by deducting medical expenses; this is called a/an | spend down
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| When a Medicaid beneficiary has no other healthcare coverage, the type of claim to be submitted is called a _____ claim. | Medicaid simple
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| A physician, practitioner, facility, or supplier with fewer than 10 FTE employees is considered a | small provider
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| A state option that provides individuals with disabilities who are eligible for nursing homes and other institutional settings with options to receive community-based services is called a/an | community first choice option
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| The act that provides for a federal system of old age, survivors, disability, and hospital insurance is the | Federal Insurance Contribution Act (FICA)
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| A federal insurance program, established in 1966, for people 65 years old and older and certain other qualifying individuals is | Medicare
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| The legal obligation of other insuring entities to pay all or part of the healthcare expenses of a Medicaid beneficiary is called | third-party liability
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| A commercial insurer contracted by the HHS for the purpose of processing and administering Medicaid claims is called a | Medicaid contractor
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| Individuals who receive medical assistance because their income falls within the poverty or FPL guidelines or as a result of SSI eligibility are considered | categorically needy
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| The acronym for the program that provides comprehensive alternative care for noninstitutionalized elderly persons who otherwise would be in a nursing home is | PACE
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| A combination federal/state medical assistance program that provides comprehensive and quality medical care for certain categories of low-income and qualifying elderly people is | Medicaid
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| Every time a claim is sent to Medicaid, a document is generated explaining how the claim was adjudicated, or how the payment was determined, which is called a/an | remittance advice
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| Part _____ of Medicare includes Medicare advantage options. | C
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| An individual who has health insurance coverage through both the Medicare and Medicaid programs is commonly referred to as a | beneficiary
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| Part _____ of Medicare helps pay for charges incurred during an inpatient hospital stay. | A
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| Part _____ of Medicare helps pay for prescription drugs. | D
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| When one state allows Medicaid beneficiaries to be treated in an adjacent state, it is referred to as | reciprocity
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| When a Medicare claim is filed, the beneficiary receives a document explaining the claim adjudication called a/an | MSN
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| An individual who is eligible for both Medicare and Medicaid programs is said to be a/an | dual eligible
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| When a healthcare provider engages in intentional misrepresentation or deception that could result in an unauthorized benefit to an individual, it is called | fraud
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| The duration of time during which a Medicare beneficiary is eligible for Part A benefits for inpatient hospital or skilled nursing facility charges is called a/an | benefit period
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