How can we help?

You can also find more resources in our Help Center.

46 terms

Health Insurance Chapter 14 T&F

Study Guide T&F and Multiple Choice
STUDY
PLAY
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