More Medicare Question Preview (ID: 48966)


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An agreement given to the patient to sign before rendering a service if the participating physician thinks that it may be denied for payment because of medical necessity or limitation of liability by Medicare is called a/an _______________.
a) fees by the health care provider, per the EOB.
b) diagnoses and procedures/services
c) Advance Beneficiary Notice of Noncoverage (ABN)
d) national provider identifiers

The Medicare program is administered by the _______________.
a) Medicare Part A
b) Centers for Medicare and Medicaid Services (CMS)
c) hospital insurance.
d) Medicare Part D

Medicare Advantage plans fall under
a) Medicare Part A.
b) Medicare Part B.
c) Medicare Part C.
d) Medigap.

Individuals younger than age 65 years who have been entitled to disability benefits under the Social Security Act or the railroad retirement system for at least 24 months are considered _______________ and are entitled to Medicare.
a) disabled
b) deceased
c) Donald Duck
d) Daisy Duck

Medicare Part B is known as
a) medical insurance
b) health insurance.
c) hospital insurance.
d) hospice insurance.

Monetary value assigned to each service based on the amount of physician work, practice expenses, and cost of professional liability insurance is called a/an
a) RVS.
b) RBRVS.
c) relative value unit.
d) relative unit.

Billing codes developed by the Health Care Financing Administration, which is now known as the Centers for Medicare and Medicaid Services (CMS), are known as
a) ICD-10-CM.
b) HCPCS.
c) national alphanumeric codes.
d) HCPCS/national alphanumeric codes

A specially qualified facility that has the staff and equipment to provide skilled medical or nursing care or rehabilitation services is called a
a) long-term care facility.
b) nursing facility.
c) hospice facility.
d) hospital facility.

A document received by the patient explaining the amount charged, Medicare-approved amount, deductible coinsurance, and payment for medical services received is called a/an
a) Medicare Summary Notice.
b) EOB.
c) remittance advice.
d)

A method of payment for Medicare hospital insurance based on DRGs (a fixed dollar amount for a principal diagnosis) is known as
a) CPT.
b) HCPCS.
c) prospective payment system.
d) ICD-10-CM.

Henry Garcia is receiving benefits simultaneously from both Medicare and Medicaid programs. An insurance claim submitted for this type of case is usually referred to as a/an
a) manual claim.
b) electronic claim.
c) supplemental claim.
d) crossover claim.

A short-term hospice inpatient stay for a terminally ill patient to give temporary relief to the caregiver is called
a) respite care.
b) hospice care
c) nursing facility care.
d) long-term care.

The time period for which payments for Medicare inpatient hospital benefits are available is known as
a) time interval.
b) benefit time.
c) supplemental benefit period.
d) benefit period.

A percentage limit on fees that nonparticipating physicians may bill Medicare beneficiaries above the fee schedule amount is called
a) approved charge.
b) limiting charge.
c) participating physician fee.
d) assignment.

The fee that Medicare decides the medical service is worth, which may or may not be the same as the actual amount billed, is known as
a) approved charge.
b) allowed limit.
c) limited fee.
d) fee-for-service.

An action to recover a penalty, brought forward by an informer in a situation in which one portion of the recovery goes to the informer and the other portion goes to the state or government, is known as
a) penal action.
b) qui tam action.
c) qui improvide.
d) penal servitude.

A program of income support for low-income aged, blind, and disabled persons established by Title XVI of the Social Security Act is called
a) Social Security.
b) Supplemental Security Income.
c) Social Security Disability Insurance.
d) Medicare Supplemental Insurance.

An organization under contract to the government that processes Medicare claims for payment is known as
a) Medicare administrative contractor/fiscal intermediary.
b) fiscal intermediary.
c) fiscal carrier.
d) Medicare administrative contractor

The desired growth rate for spending on Medicare Part B physician services that is set each year by Congress is known as
a) geographic practice cost indices.
b) resource-based relative value scale.
c) volume performance standard.
d) indemnity ratio.

Medicare Part A is known as
a) supplementary medical insurance.
b) health insurance.
c) hospital insurance.
d) hospice insurance.

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