Marcy Medical Insurance Quiz 3

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Quiz #3 study guide

The Omnibus Budget Reconciliation Act

provided assistance for the aged and disabled who are receiving Medicare and whose incomes are below the poverty level

The wife of a veteran with total permanent disability resulting from a service-connected injury is eligible for CHAMPVA benefits

as long as she is not eligible for TRICARE Standard
as long as she is not eligible for Medicare Part A

The letters preceding the number on the patient's Medicare identification card indicate

railroad retiree

The patient's authorized signature is not required on the CMS-1500 claim form for Medicare-Medicaid cases

true

Medicare's Remittance Advice document was formerly known as the Explanation of Medicare Benefits

true

When a Medicare patient signs an advance beneficiary notice, the procedure code for the service provided must be modified using the HCPCS Level II modifier

-GA

A physician may accept or refuse Medicaid patients on the basis of the individual patient and his or her circumstances

false

TEFRA stands for Tax Equity and Financial Reimbursement Act.

false

TRICARE, formerly known as CHAMPUS, is funded through

Congress.

Medicaid is available to needy and low-income people such as

the blind.
the disabled.
the aged (65 years or older).

A physician who chooses not to participate in TRICARE bills

no more than 115% of the TRICARE allowable charge

The Omnibus Budget Reconciliation Act

provided assistance for the aged and disabled who are receiving Medicare and whose incomes are below the poverty level.

When a remittance advice (RA) is received from Medicare, the insurance billing specialist should

post each patient's name and the amount of payment on the day sheet and the patient's ledger card

The federal government financially supports the minimum assistance level of the medically needy aged, and the states must wholly support any part of the program that goes beyond the federal minimum.

True

The Medicaid patient may be responsible for a copayment

True

If a physician accepts Medicaid patients, the physician must accept

the Medicaid-allowed amount

The medically needy aged

require help in meeting costs of medical care

It is possible for a Medicaid patient to be on Medicaid 1 month and off Medicaid the following month.

True

In the Medicare program, there is mandatory assignment for

clinical laboratory tests

It is not possible for an immigrant to have Medicaid coverage

False

Individuals who qualify for TRICARE are known as subscribers

False

The Part B Medicare annual deductible is

$135

The gatekeeper in a Medicaid managed care program is the specialist to whom the patient is referred

False

The gatekeeper in a Medicaid managed care program is the specialist to whom the patient is referred

False

It is not possible for a person to be eligible for Medicaid benefits and also have additional group health insurance coverage

False

When Medicaid and a third-party payer cover the patient, Medicaid is always the payer of last resort.

True

A Medicare patient with an HMO does not need a supplemental insurance policy

True

The patient's authorized signature is not required on the CMS-1500 claim form for Medicare-Medicaid cases.

True

It is possible for an alien to be eligible for Medicare Part A and Part B.

True

State Children's Health Insurance Programs (SCHIPs)

operate with federal grant support under Title V of the Social Security Act

If a check is received from Medicare and it is obvious that it is an overpayment, the insurance billing specialist should

deposit the check and then write to Medicare to notify them of the overpayment

A physician may accept or refuse Medicaid patients on the basis of the individual patient and his or her circumstances

False

Medicare's Remittance Advice document was formerly known as the Explanation of Medicare Benefits.

True

Each Medicare hospital benefit period consists of 60 consecutive days in a hospital or nursing facility

False

The 1987 Omnibus Budget Reconciliation Act (OBRA) established

MAAC.

Medicaid is administered by the

state government with partial federal funding

Nonparticipating physicians have an option regarding accepting assignment on the Medicare patient.

True

The wife of a veteran with total permanent disability resulting from a service-connected injury is eligible for CHAMPVA benefits

as long as she is not eligible for TRICARE Standard.
as long as she is not eligible for Medicare Part A.

The time limit to appeal a claim varies from state to state, but it is usually

30 to 60 days.

The time limit for sending in Medicare claims is the end of the calendar year in which professional services were performed

False

Prior approval or authorization is never required in the Medicaid program

False

All states processing medical claims must bill using the CMS-1500 claim form

True

The HCPCS national alphanumeric codes are referred to as

Level II codes.

When a Medicare patient signs an advance beneficiary notice, the procedure code for the service provided must be modified using the HCPCS Level II modifier

-GA.

The time limit for submitting a Medicare claim is

the end of the calendar year following the fiscal year in which services were performed

The Medicaid service for prevention, early detection, and treatment for welfare children is known as

EPSDT

The three choices of health care coverage for families of active duty military personnel, military retirees, and their dependents are

TRICARE Standard, TRICARE Prime, and TRICARE Extra.

Patients who elect Medicare Part B coverage pay annually increasing basic premium payments

True

Medicaid is not so much an insurance program as an assistance program

True

Part B of Medicare covers

diagnostic tests

The TRICARE fiscal year extends from

October 1 to September 30.

TEFRA stands for Tax Equity and Financial Reimbursement Act

False

A nonparticipating physician who is not accepting assignment may bill any fee he or she wishes

False

The time limit within which a TRICARE outpatient claim must be filed is

within 1 year from the date a service is provided

The federal government designs the Medicaid program for each state on the basis of the needs of the state

False

The patient's Medicaid card must be checked each time the patient visits the physician's office to verify eligibility for month of service

True

In some cases the welfare office may grant retroactive eligibility to a patient

True

For a CHAMPVA beneficiary, if the physician is nonparticipating and does not accept assignment, the patient completes the top portion of the CMS-1500 claim form, attaches an itemized statement from the physician, and submits the claim

True

Providers may choose to accept TRICARE assignment on a case-by-case basis

True

The letters preceding the number on the patient's Medicare identification card indicate

railroad retiree.

All Privacy Act requests from patients must be made in writing

False

If a service is totally disallowed by Medicaid, a physician is within legal rights to bill the patient

True

The time limit within which a TRICARE inpatient claim must be filed is within

1 year from a patient's discharge from an inpatient facility

The federal government designs the Medicaid program for each state on the basis of the needs of the state.

False

An NAS certification is required for all TRICARE Standard, TRICARE Extra, and CHAMPVA beneficiaries who wish to receive treatment as inpatients at a civilian hospital and who live within a catchment area surrounding a Uniformed Services medical treatment facility

False

The federal government determines the payment for medical services in the Medicaid program

False

Part A of Medicare covers

hospice care

Medicare transmits Medigap claims electronically for participating physicians when Medigap information is provided on the original Medicare claim

True

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