Med Ins & Billing (Ch 9 & 10) - Interactive
Activity - Medicare/Medicaid Questions
and Answers | Latest Version | 2024/2025
| Correct & Verified
What is Medicaid?
✔✔Medicaid is a joint federal and state program that provides health coverage for people with
low income and limited resources.
What is the difference between Medicare and Medicaid?
✔✔Medicare is for seniors and certain disabled individuals, while Medicaid is designed for low-
income individuals, families, and children.
How does Medicare Part A billing work?
✔✔Medicare Part A billing covers inpatient hospital stays, skilled nursing care, and hospice.
Hospitals directly bill Medicare for these services.
How does Medicare Part B billing work?
✔✔Medicare Part B covers outpatient services, including doctor visits and preventive services.
Providers submit claims to Medicare for reimbursement.
1
,What is the role of a Medicare Advantage plan in billing?
✔✔Medicare Advantage plans provide Part A and Part B services through private insurers, and
they handle billing directly with the healthcare providers.
How does Medicaid billing work?
✔✔Medicaid billing is processed by state Medicaid programs, and healthcare providers must be
enrolled with the state to receive payment for services provided to Medicaid recipients.
What is a "Medicare assignment" in medical billing?
✔✔Medicare assignment means the provider agrees to accept the Medicare-approved amount as
full payment for services. The patient is only responsible for the deductible and coinsurance.
What is a co-payment in Medicare billing?
✔✔A co-payment is the fixed amount a patient pays for a medical service, such as a doctor’s
visit or prescription, after meeting their deductible.
How does Medicaid reimbursement differ from Medicare?
2
, ✔✔Medicaid reimbursement rates are typically lower than Medicare's and vary by state.
Medicaid also covers a broader range of services, including long-term care.
What is a Medicare Advantage out-of-pocket maximum?
✔✔Medicare Advantage plans have an out-of-pocket maximum, which limits how much a
beneficiary will pay for services in a given year. Once this amount is reached, the plan pays
100% of covered services.
What is the Medicaid managed care program?
✔✔Medicaid managed care programs are insurance plans that offer a range of services to
Medicaid beneficiaries through private insurers, who receive a fixed monthly payment.
What is the role of the Medicare Administrative Contractor (MAC)?
✔✔MACs are private companies that process Medicare claims and provide administrative
services, such as billing and reimbursement to healthcare providers.
What does "balance billing" mean in Medicare?
3
Activity - Medicare/Medicaid Questions
and Answers | Latest Version | 2024/2025
| Correct & Verified
What is Medicaid?
✔✔Medicaid is a joint federal and state program that provides health coverage for people with
low income and limited resources.
What is the difference between Medicare and Medicaid?
✔✔Medicare is for seniors and certain disabled individuals, while Medicaid is designed for low-
income individuals, families, and children.
How does Medicare Part A billing work?
✔✔Medicare Part A billing covers inpatient hospital stays, skilled nursing care, and hospice.
Hospitals directly bill Medicare for these services.
How does Medicare Part B billing work?
✔✔Medicare Part B covers outpatient services, including doctor visits and preventive services.
Providers submit claims to Medicare for reimbursement.
1
,What is the role of a Medicare Advantage plan in billing?
✔✔Medicare Advantage plans provide Part A and Part B services through private insurers, and
they handle billing directly with the healthcare providers.
How does Medicaid billing work?
✔✔Medicaid billing is processed by state Medicaid programs, and healthcare providers must be
enrolled with the state to receive payment for services provided to Medicaid recipients.
What is a "Medicare assignment" in medical billing?
✔✔Medicare assignment means the provider agrees to accept the Medicare-approved amount as
full payment for services. The patient is only responsible for the deductible and coinsurance.
What is a co-payment in Medicare billing?
✔✔A co-payment is the fixed amount a patient pays for a medical service, such as a doctor’s
visit or prescription, after meeting their deductible.
How does Medicaid reimbursement differ from Medicare?
2
, ✔✔Medicaid reimbursement rates are typically lower than Medicare's and vary by state.
Medicaid also covers a broader range of services, including long-term care.
What is a Medicare Advantage out-of-pocket maximum?
✔✔Medicare Advantage plans have an out-of-pocket maximum, which limits how much a
beneficiary will pay for services in a given year. Once this amount is reached, the plan pays
100% of covered services.
What is the Medicaid managed care program?
✔✔Medicaid managed care programs are insurance plans that offer a range of services to
Medicaid beneficiaries through private insurers, who receive a fixed monthly payment.
What is the role of the Medicare Administrative Contractor (MAC)?
✔✔MACs are private companies that process Medicare claims and provide administrative
services, such as billing and reimbursement to healthcare providers.
What does "balance billing" mean in Medicare?
3
