Chap. 12 Reimbursement

Created by ellsworthkelly 

Upgrade to
remove ads

Medicare provides insurance for disablled individuals if they have received Social Security disability benefits for 24 months.

True

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

True

Whan a Medicare recipient chooses a Medicare senior plan, he or she forfeits the Medicare card.

False

Nonparticipating physicians have an option regarding addpting assignment on a Medicare patient.

True

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

False

Because Medicare is a federal program providing uniform benefits, payment of each medical service rendered to Medecare patient is consistent across the United States.

False

Medicare Part B insurance payments aree handled by the National Blue Cross Association.

False

When a CMS-1500 claim form is automatically transferred by Medicar to a Medigap carrier, there is no need to obtain a separate signature authorization for the Medigap carrier.

True

The assignment on a patient with Medicare-Medicaid must alwys be accepted or Medicaid will no pick up the residual.

False

Medicare Part-A is run by

The Centers for Medicare and Medicaid Services.

Medicare is a

Federal health insurance program

The letter "D" following the identification number on the patient's Medicare card indicates a

widow

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

railroad retiree

Part A of Medicare covers

hospice care

Part B of Medicare covers

diagnostic tests

Medicare Part A benefit period endsw when a patient

has not been a bed patient in any hospital or nursing facility for 60 consecutive days

The Part B Medicare annual deductible is

$135

Medicare provides a one-time baseline mammographic examination for women ages 35 to 39 and preventive mammogram screenings for women 40 years or older

once a year

The frequency of Pap testss that may be billed for a Medicare patient who is low risk is

once every 24 months

Medigap insurance may cover

80% of the Medicare allowed amount

When a Medicare beneficiary has employer supplemental coverage, Medicare refvers to these plans as

MSP

Some senior HMOs may provide services not covered by Medicare, such as

eyeglasses and prescription drugs

A state-based group of doctors working under government guidelines reviewing cases for hospital admission and discharge is known as a

QIO

A participating physician with the Medicare plan agrees to accept

80% of the Medicare-approved charge

In the Medicare program, there is mandatory assignment for

surgery performed in the physician's office

A Medicare prepayment screen

identifies claims to review for medical necessity

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

Under the prospective payment system (PPS), hospitals treating Medicare patients are reimbursed according to

preestablished rates for each type of illness treated based on diagnosis

Payments to hospitals for Medicare services are classified according to

DRG's

The 1987 Omnibus Budget Reconciliation Act (OBRA) established the

MAAC

The HCPCS national alphanumeric codes are referred to as

Level II Codes

Organizations handling claims from hospitals, nursing facilities, intermediate care facilities, long-term care facilities, and home health agencies are called

fiscal intermeiaries

The time limit for submitting a Medecare claim is

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

When a Medicare carrier transmits a Medigap claim electronically to the Medigap carrier, it is referred to as

a crossover claim

An explanation of benefits document for a patient under the Medicare program is referred to as the

Medicare remittance advice document

A claims assistance professional (CAP)

may act on the Medicare beneficiary's behalf as a client representative

Whe a remittance advie (RA) is received for 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

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

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

Medicare provides insurance for people who are this old or older who are retire on Social Security

65

Medicare outpatient coverage is referred to as Part

B

This alpha letter follow the identification number on a female patient's Medicare card indicates that is is her husband's number

b

A specialized insurance policy that is predefined by the federal government for the Medicare beneficiary to cover the deductible and copayment amounts is referred to as

premium

The Civil Monetary Penalties Law carries a sanction for a penalty of up to this much for each item or service wrongfully listed in a payment request to Medicare or Medicaid

$10,000

A Medicare non participating physician may bill no more than the Medicare

lending charge

The Medicare HCPCS coding system has this many levels

3

Organizations handling claims for physicians and other supplier of services covered under medicare Part B are called fiscal intermediaries or

MAC

When a Medicare patient's payment authorization is on file, this abbreviation may be used on the CMS-1500 claim form

SOF

An NPI number issued to a provider by CMS is the acronym for

National Provider Identifier

Please allow access to your computer’s microphone to use Voice Recording.

Having trouble? Click here for help.

We can’t access your microphone!

Click the icon above to update your browser permissions above and try again

Example:

Reload the page to try again!

Reload

Press Cmd-0 to reset your zoom

Press Ctrl-0 to reset your zoom

It looks like your browser might be zoomed in or out. Your browser needs to be zoomed to a normal size to record audio.

Please upgrade Flash or install Chrome
to use Voice Recording.

For more help, see our troubleshooting page.

Your microphone is muted

For help fixing this issue, see this FAQ.

Star this term

You can study starred terms together

NEW! Voice Recording

Create Set