Medicare-State Exam Study with Absolute Solution

Medicare-State Exam Study with Absolute Solution Medi-Medi beneficiary - An individual who is eligible for both Medicaid and Medicare is a______. Medigap insurance policies - Medicare Part B deductibles, coinsurance,and some noncovered services can be covered by buying policies from federally approved private insurance carriers. These policies are known as_____. crossover claims - Claims for Medi-Medi beneficiaries are first submitted to Medicare and then sent to Medicaid, making them known as_____. additional payment - What can a provider earn via the PQRS program? voluntary program for Medicare - PQRS is a_________. workers compensation or federal black lung benefits - Medicare is the secondary payer when the patient has____. notices sent to physicians with information about the coding and medical necessity of service - What is the Local Coverage Determination (LCD)? Option 2 - Which option on an ABN allows the beneficiary to receive the non-covered items and services and pay for them out of pocket? deductible - Each calender year, Medicare enrollees must satisfy a_____for covered services under which Medicare Part B. if the patients is treated regardless of participation - When are physicians required to file claims for their patients who are Medicare beneficiaries? Medicare Summary Notices - What do beneficiaries receive to explain the charges paid and due? physician choices limited to those in the particular plans network - Medicare coordinated care plans have which of these disadvantages? Medical Savings Account (MSA) - The plan that combines a high-deductible fee-for-service plan with a tax-exempt trust to pay for qualified medical expenses is the_____. Medicare Fee Schedule(MFS) - What national system is based on the resource-Based Relative value Scale (RBRVS) system using cost factors that represent the physicians time and how much it costs to run/insure a practice? participating - Physicians who agree to accept assignment for all Medicare claims and to accept Medicares allowed Charge according to the Medicare Fee Schedule as payment in full for services are classified as_____. both unintentional coding error and intentionally incorrect coding done to increase payments - The Medicare Correct Coding Initiative (CCI) is designed to correct what types of errors? timely filing - Medicare law sets specific guidelines regarding what aspect of submitting claims for benefits? on or before August 31, 2015 - Under Medicares timely filing guidelines when would the claim for a patient who received surgery in August of 2014 need to be filed? an unavoidable delay - late claims files with Medicare might still be accepted if a valid explanation is given such as______. Advance Beneficiary Note of Noncoverage (ABN) - Before a practice provides an excluded service to a patient the patient may be given written notification using the CMS form____. Advance Beneficiary Notice of Noncoverage(ABN) - If a provider thinks a procedure will not be covered by Medicare because it will be deemed not reasonable and necessary he/she must notify the patient before the treatment using a standard______. an explanation and evidence to support it - When filling a late claim with Medicare what evidence needs to be sent attached? accept assignment on a particular claim - A nonPAR may_____. any licensed certified by Medicare - Medicare beneficiaries who enroll in the Original Medicare Plan can choose______. Both MRN and MSN - The amount of a patients medical bills that has been applied to the annual deductible is shown on the____. minimal paperwork - Medicare coordinated care plans are managed care policies which may offer beneficiaries which of these advantages: medicare Part D - What part of Medicare is authorized under the MMA and provides voluntary Medicare prescription drug plans that are open to people who are eligible for Medicare? Medicare Part C - What part of Medicare became available in 1997 to individuals who are eligible for Part A and enrolled in Part B? formulary - A prescription drug plan has a list of drugs it covers, called a_______. NCD - What is a policy that states whether and under what circumstances a service is covered? Medicare private fee-for-service - Under which type of Medicare plan can patients receive services from Medicare-approved providers or facilities of their choosing? they are paid 5% more - What advantage do participating providers in Medicare have other those who don't? prescription drug benefit plan - Medicare Part D is a_____. Medicare Part B - What part of Medicare helps pay for physician services, outpatient hospital services, durable medical equipment, and other services and supplies? Medicare beneficiary - A person covered Medicare is called a____. Medicare administrative contractors - Insurance companies that process claims for doctors hospitals skilled nursing facilities intermediate care facilities long term care facilities and home health care agencies are known as_____. Medicare - The federal health insurance program for people who are sixty-five or older is known as_____. Section 3 - Which section on the ABN includes the Options Box. claim was not sent in a timely fashion - 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 99213 and a diagnosis code code of M25.569. No payment is sent back. What is the most probable reason why it was sent with no payment? Section 5 - Where on the ABN is the Signature Box? annual deductible and coinsurance - With the Original Medicare plan, beneficiaries are responsible for: Medigap - What do some individuals use to help pay for additional costs that Original Medicare Plan does not cover?