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Chap. 12 Reimbursement

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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