Question 1

An individual who is eligible for both Medicaid and Medicare is a

Accepted Answer

A)   double beneficiary
B)   Medicare Part C beneficiary
C)   Medi-Medi beneficiary
D)   None of theseE) B) and D)
F) C) and D)

Question 2

A nonPAR may

Accepted Answer

A)   accept assignment on a particular claim
B)   balance bill patients
C)   refuse to file claims
D)   All of theseE) B) and D)
F) B) and C)

Question 3

The insurance plan that pays first when a patient is covered by more than one medical insurance plan is called the

Accepted Answer

A)   primary payer
B)   secondary payer
C)   intermediary payer
D)   principal payerE) All of the above
F) B) and D)

Question 4

People who are entitled to Medicare Part A benefits automatically qualify for Medicare

Accepted Answer

A)   Part B
B)   Part X
C)   Part H
D)   Part EE) A) and B)
F) A) and C)

Question 5

Medicare coordinated care plans have which of these disadvantages?

Accepted Answer

A)   physician choices limited to those in the particular plan's network
B)   coverage for additional services
C)   no need for a supplemental Medigap policy
D)   there are no disadvantagesE) A) and B)
F) B) and C)

Question 6

Which is accurate about sending Medicare claims?

Accepted Answer

A)   must be on paper form
B)   must be sent electronically
C)   an RA must be attached
D)   has to be sent within 3 months of the date of serviceE) None of the above
F) A) and C)

Question 7

When are physicians required to file claims for their patients who are Medicare beneficiaries?

Accepted Answer

A)   only if they accept assignment
B)   after the annual deductible is met
C)   before the annual deductible is met
D)   if the patient is treated, regardless of participationE) None of the above
F) B) and D)

Question 8

What advantage do participating providers in Medicare have over those who don't?

Accepted Answer

A)   they are paid 5% more
B)   they are paid 10% more
C)   they are processed quicker
D)   they accumulate incentivesE) A) and B)
F) A) and C)

Question 9

An established patient is seen with a participating provider of Medicare for an office visit on August 13th for knee pain, gets a joint injection, and the electronic claim is sent on September 1st of the following year. The claim is sent out with an office visit code of 99213 and a diagnosis code of M25.569. No payment is sent back. What is the most probable reason why it was sent with no payment?

Accepted Answer

A)   incorrect codes
B)   it was not sent on a paper form
C)   it was a non-participating provider
D)   claim was not sent in a timely fashionE) None of the above
F) All of the above

Question 10

Which is the deadline for sending Medicare claims?

Accepted Answer

A)   18 months of the date of service
B)   12 months of the date of service
C)   6 months of the date of service
D)   3 months of the date of serviceE) All of the above
F) B) and D)

Question 11

What is Local Coverage Determination (LCD) ?

Accepted Answer

A)   Notices sent to physicians with information about the coding and medical necessity of a service.
B)   Guide that gives local providers that are covered by Medicare
C)   Form used to inform patients that a service is not likely to be reimbursed.
D)   Policy stating whether and under what circumstances a service is covered.E) A) and B)
F) All of the above

Question 12

When filing a late claim with Medicare, what evidence needs to be sent attached?

Accepted Answer

A)   a walkout receipt
B)   an RA
C)   an explanation and evidence to support it
D)   forgiveness letterE) None of the above
F) B) and D)

Question 13

People who are over age 65, who do not receive Social Security benefits may enroll in Medicare Part A by

Accepted Answer

A)   paying a deductible
B)   paying a premium
C)   paying into a Medical Savings Account
D)   enrolling in a Medicare HMOE) B) and C)
F) A) and D)

Question 14

What does the Patient Protection and Affordable Care Act, or PPACA, change?

Accepted Answer

A)   timely filing of claims for Part B providers
B)   timely filing of claims for Part C providers
C)   claims must be sent electronically
D)   claims must be sent through a paper formE) B) and D)
F) None of the above

Question 15

Medicare beneficiaries who enroll in the Original Medicare Plan can choose

Accepted Answer

A)   any licensed physician
B)   in which part of Medicare they would like to participate
C)   their coinsurance rates
D)   any licensed physician certified by MedicareE) B) and C)
F) A) and D)

Question 16

What can be used to speed Medicare denials so the amount due can be collected from the patient (or a secondary payer) ?

Accepted Answer

A)   GY modifier
B)   HU modifier
C)   remittance advice
D)   walkout receiptE) A) and D)
F) None of the above

Question 17

Where on the ABN is the Signature Box?

Accepted Answer

A)   Section 3
B)   Section 4
C)   Section 5
D)   Section 6E) A) and B)
F) A) and C)

Question 18

What do beneficiaries receive to explain the charges paid and due?

Accepted Answer

A)   Receipt
B)   Remittance Advise
C)   Explanation of Benefits
D)   Medicare Summary NoticesE) A) and B)
F) All of the above

Question 19

What part of Medicare allows private health insurance companies to contract with CMS to offer Medicare benefits through their own policies?

Accepted Answer

A)   Medicare Part A
B)   Medicare Part B
C)   Medicare Part C
D)   Medicare Part DE) B) and C)
F) All of the above

Question 20

Medicare Part D is a(n)

Accepted Answer

A)   prescription drug benefit plan
B)   hospice plan
C)   hospital plan
D)   outpatient surgery planE) B) and C)
F) A) and D)

Exam 9: Medicare

Medicare coordinated care plans have which of these disadvantages?

Correct Answer
verified

What can be used to speed Medicare denials so the amount due can be collected from the patient (or a secondary payer) ?

Correct Answer
verified

People who are entitled to Medicare Part A benefits automatically qualify for Medicare

Correct Answer
verified

The insurance plan that pays first when a patient is covered by more than one medical insurance plan is called the

Correct Answer
verified

When filing a late claim with Medicare, what evidence needs to be sent attached?

Correct Answer
verified

What advantage do participating providers in Medicare have over those who don't?

Correct Answer
verified

People who are over age 65, who do not receive Social Security benefits may enroll in Medicare Part A by

Correct Answer
verified

Medicare beneficiaries who enroll in the Original Medicare Plan can choose

Correct Answer
verified

What part of Medicare allows private health insurance companies to contract with CMS to offer Medicare benefits through their own policies?

Correct Answer
verified

Medicare Part D is a(n)

Correct Answer
verified

Correct Answer
verified

When are physicians required to file claims for their patients who are Medicare beneficiaries?

Correct Answer
verified

What does the Patient Protection and Affordable Care Act, or PPACA, change?

Correct Answer
verified

Which is the deadline for sending Medicare claims?

Correct Answer
verified

Which is accurate about sending Medicare claims?

Correct Answer
verified

What do beneficiaries receive to explain the charges paid and due?

Correct Answer
verified

Where on the ABN is the Signature Box?

Correct Answer
verified

A nonPAR may

Correct Answer
verified

An individual who is eligible for both Medicaid and Medicare is a

Correct Answer
verified

What is Local Coverage Determination (LCD) ?

Correct Answer
verified

Exam 9: Medicare

Medicare coordinated care plans have which of these disadvantages?

Correct AnswerverifiedShow Answer

What can be used to speed Medicare denials so the amount due can be collected from the patient (or a secondary payer) ?

Correct AnswerverifiedShow Answer

People who are entitled to Medicare Part A benefits automatically qualify for Medicare

Correct AnswerverifiedShow Answer

The insurance plan that pays first when a patient is covered by more than one medical insurance plan is called the

Correct AnswerverifiedShow Answer

When filing a late claim with Medicare, what evidence needs to be sent attached?

Correct AnswerverifiedShow Answer

What advantage do participating providers in Medicare have over those who don't?

Correct AnswerverifiedShow Answer

People who are over age 65, who do not receive Social Security benefits may enroll in Medicare Part A by

Correct AnswerverifiedShow Answer

Medicare beneficiaries who enroll in the Original Medicare Plan can choose

Correct AnswerverifiedShow Answer

What part of Medicare allows private health insurance companies to contract with CMS to offer Medicare benefits through their own policies?

Correct AnswerverifiedShow Answer

Medicare Part D is a(n)

Correct AnswerverifiedShow Answer

Correct AnswerverifiedShow Answer

When are physicians required to file claims for their patients who are Medicare beneficiaries?

Correct AnswerverifiedShow Answer

What does the Patient Protection and Affordable Care Act, or PPACA, change?

Correct AnswerverifiedShow Answer

Which is the deadline for sending Medicare claims?

Correct AnswerverifiedShow Answer

Which is accurate about sending Medicare claims?

Correct AnswerverifiedShow Answer

What do beneficiaries receive to explain the charges paid and due?

Correct AnswerverifiedShow Answer

Where on the ABN is the Signature Box?

Correct AnswerverifiedShow Answer

A nonPAR may

Correct AnswerverifiedShow Answer

An individual who is eligible for both Medicaid and Medicare is a

Correct AnswerverifiedShow Answer

What is Local Coverage Determination (LCD) ?

Correct AnswerverifiedShow Answer

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