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Marcy Medical Insurance Quiz 3

Quiz #3 study guide
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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