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24 terms

week 6

STUDY
PLAY
TRUE
The Health Maintenance Organization Act 1973 required most employers to offer HMO coverage to their employees as an alternative to traditional heath insurance.
FALSE
Managed care plans allow laboratory test to be preformed at any facility the patient chooses.
TRUE
Patients who elect Medicare Part B coverage pay annually increasing basic premium payments.
TRUE
If a primary care physician sends a patient to a specialist for consultation and the specialist is nor in the managed care plan, the specialist may bill the primary care physician for payment.
TRUE
The assignment on a patient with medicare-medicaid must always be accept or medicaid will not pick up the residental
TRUE
A co-payment in managed care plan is usually a fixed dollar amount (predertermined fee).
FALSE
Medicare Part A is called supplementary medical insurance (SMI).
FALSE
When CMS-1500 claim form is automatically transferred by Medicare to a Medigap carrier, there is no need to abtain a separate signature authorization for the Medigap carrier.
TRUE
Medicare provides insurance for disabled individuals if they have recieved Social Security disability benefits for 24 months.
FALSE
Medicare-eligible patients are not involved with HMOs or prepaid health plans,
FALSE
Managed care plans never require a CMS-1500 claim form to be completed and submitted
FALSE
All persons age 65 who meet elgibility requirements for Medicare recieve Medicare Part B (outpatient coverage).
FALSE
Once a outpatient changes from Medicare to a senior HMO, the patient must stay with that HMO for the remainder of the calender year.
TRUE
Usually, there are no deductibles for managed care plans.
TRUE
A Medicare patient with an HMO does not need a supplement insurance policy.
TRUE
It is possible for an alien to be eligible for Medicare Part A and Part B.
TRUE
In a point of service (POS) program, members may choose to use a nonprogram provider at the time.
TRUE
In certain managed care plans there is an incentive for the gatekeeper to limit patient referrals to specialists.
TRUE
Medicare transmits Medigap claims electronically for participating physicians when medigap information is provided on the oringinal Medicare claim.
FALSE
In the Medicare program, a physical examination is covered benefit when preformed within 12 months of enrollment.
TRUE
Employee and employer contributions help pay for Medicare Part A health services.
FALSE
When Medicare recipient chooses a Medicare senior plan, he or she forfeits the Medicare card.
TRUE
The term "turfing" means to tranfer the sickest high-cost patients to other physicians so that the provider appears as low utilizer.
TRUE
Medicare provides insurance for disabled workers for any age.