Health Insurance Chapter 14 T&F

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Study Guide T&F and Multiple Choice

True

Medicare is the largest single medical benefits program in the US

False

The AMA is responsible for the operation of the Medicare program and for selecting Medicare administrative contractors (MACs)

True

Medicare Part D is a prescription drug coverage plan

False

Medicare Savings Programs help people with high income and asset levels pay for health care coverage

False

A benefit period begins the first day the patient visits the physician and ends when the patient is cured/healed

False

Life time reserve days (45 days) may be used only once during a patient's lifetime and are usually reserved for use during the patient's final, terminal hospital stay

True

Medicare Part B also covers some home health services if the patient is not covered by Medicare Part A

True

Medicare limits hospice care to four benefit periods: two periods of 90 days each, one 30-day period, and a final "lifetime" extension of unlimited duration

False

Respite care is the permanent hospitalization of a terminally ill, dependent hospice patient for the purpose of providing relief for the nonpaid person who has the major day-to-day responsibility for care of that patient

True

When a patient chooses Medicare hospice benefits all other Medicare benefits stop, with the exception of physician services or treatment for conditions not related to the patient's terminal diagnosis

True

Medicare Part B helps cover physician services, outpatient hospital care, and other services not covered by Medicare Part A

True

One way to join a Medicare Prescription Plan requires subscribers to pay a monthly premium and an annual deductible

False

Medigap is designed to supplement all insurance benefits by paying for services that they do not cover

False

A demonstration/pilot program is a special project that tests improvements in Medicare benefits

False

The goal of PACE is to help patients find the appropriate skilled nursing care

C. Medicare

The largest single medical benefits program in the United States is ____?
A. Blue Cross/Blue Shield
B. Medicaid
C. Medicare
D. Aetna

B. Institutional Providers for Inpatient Services

Medicare Part A covers _____?
A. Institutional Providers for Outpatient services
B. Institutional Providers for Inpatient Services
C. Managed Care and Private fee-for-service Plans that contract with Medicare
D. Fees not reimbursed by Medicare

C. Physician services, outpatient hospital care, and other services not covered by Medicare Part A

Medicare Part B covers ____?
A. Costs not reimbursed by the original Medicare plan
B. Managed care and fee-for-service plans that contract with Medicare
C. Physician services, outpatient hospital care, and other services not covered by Medicare Part A
D. Institutional providers for inpatient services

C. Medigap

All Medicare beneficiaries can also obtain a supplemental insurance policy called ____?
A. Medisup
B. Medical
C. Medigap
D. Medipol

D. All of the above

General Medicare eligibility requires an individual or their spouse to ____?
A. Be a minimum of 65 years of age
B. Be a citizen or permanent resident of the United states
C. Have worked at least 10 years in Medicare-covered employment
D. All of the above

A. They or their spouse paid Medicare taxes while they were working

Individuals age 65 or over do not pay a monthly premium for Medicare Part A if ____?
A. They or their spouse paid Medicare taxes while they were working
B. They or their spouse paid Federal taxes while they were working
C. They or their spouse subscribe to Medicare Part B
D. None of the above

D. 60

A benefit period begins with the first day of hospitalization and ends when a patient has been out of the hospital for ____ consecutive days.
A. 15
B. 35
C. 45
D. 60

D. Both B and C

The benefit period was formerly known as ___?
A. Accident party
B. Spell of illness
C. Spell of Sickness
D. Both B and C

C. 190

Persons confined to a psychiatric hospital are allowed ___ lifetime reserve days instead of the 60 days allotted for stay in an acute care hospital.
A. 45
B. 75
C. 190
D. 175

D. Both A and B

Hospice care is provided when
A. The provider can do nothing further to stop the progression of disease
B. The patient is treated only to relieve pain or other discomfort
C. The patient is improving
D. Both A and B

C. B

Medicare Part __ helps cover physician services, outpatient hospital care, physical and occupational therapy, and some home health care.
A. D
B. C
C. B
D. A

D. Both B and C

Medicare reimburses provider services according to ____?
A. A physician billing schedule
B. A physician fee schedule
C. Resource-Based Relative Value Scale
D. Both B and C

D. All of the above

RVUs consider resources used in providing a service, such as ____
A. Physician work
B. Practice expense
C. Malpractice expense
D. All of the above

C. To help people stay independent and live in their community as long as possible

The goal of Programs of All-Inclusive Care for the Elderly is ___?
A. To offer palliative care at the end of life
B. To help people become eligible for nursing care by the appropriate state agency
C. To help people stay independent and live in their community as long as possible
D. All of the above

D. All of the above

Special incentives mandated by Congress to increase the number of health care providers signing participating provider agreements with Medicare include ____?
A. Direct payment of all claims
B. A 5% higher fee schedule
C. Publication of PAR directory to all Medicare patients
D. All of the above

Medically Unlikely Edit

MUE

Local Coverage Determination

LCD

National Provider Identifier

NPI

Special Enrollment Period

SEP

Medicare Administrative Contractor

MAC

National Coverage Determination

NCD

National Correct Coding Initiative

NCCI

Medigap

MG

Qualifying Individual

QI

Advance Beneficiary Notice

ABN

Place of Service

POS

Initial Enrollment Period

IEP

General Enrollment Period

GEP

Medicare Physician Fee Schedule

MPFS

Medicare Secondary Payer

MSP

True

Whenever a beneficiary has Medicare and another insurance (primary or secondary to Medicare) 2 boxes will be marked with an X in block 1

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