Final Exam Review - MAP
In the Medicare program, the notice the patient receives describing how the claim was adjudicated and
paid is called an Advance Beneficiary Notice. - Answer-False
When a service or procedure meets Medicare's or Medicaid's criteria for coverage and payment, it is
said to be: - Answer-medically necessary
A private organization, usually another medical insurance company, that contracts with the federal
government to adjudicate and pay Medicare Part B claims in a region is called a: - Answer-carrier
This "part" of the traditional Medicare program pays for inpatient hospital care, home health care, and
skilled nursing care. - Answer-Part A
The Medicare Part B coinsurance is 70% of allowed charges after the annual Part B deductible has been
met. - Answer-False
The difference between what the provider charges and the basis on which Medicare or Medicaid will
pay is called the: - Answer-contractual adjustment
When a Medicaid beneficiary has no other health care coverage, the type of claim that is submitted is
called a: - Answer-Medicaid simple claim
When one state allows Medicaid beneficiaries to be treated in an adjacent state, it is referred to as: -
Answer-reciprocity
,After verifying the Medicaid patient's name and demographic information against their Medicaid card
and picture ID, always check this before providing service: - Answer-their current period of eligibility
The Medicare and Medicaid programs are administered by this federal agency: - Answer-CMS
Medically needy individuals can reduce their assets to the Medicaid eligibility level by using assets to pay
for medical care in a process called: - Answer-spend down
When an individual is covered under both Medicaid and Medicare and/or a private health care policy,
Medicaid is always the "payer of last resort". - Answer-True
All Medicaid plans are strictly fee-for-service and managed care types of programs do not exist with
state Medicaid programs. - Answer-False
When Medicare automatically forwards claim and payment information to the supplemental insurance
plan, such as Medicaid, the process is called a: - Answer-crossover
This "part" of the traditional Medicare program pays for physician services, outpatient services, and
durable medical equipment: - Answer-Part B
Medicaid eligibility should be verified every single time the Medicaid patient arrives for services. -
Answer-True
Local Coverage Determinations focus on the types of medical services individual Medicare contractors
agree to cover. - Answer-False
Once a patient qualifies for Medicaid, they remain eligible for life. - Answer-False
In order to qualify for Medicaid, an individual must be categorically or medically needy. - Answer-True
, The Part B premium is usually deducted from the beneficiary's monthly social security check. - Answer-
True
Medicare supplemental plans that cover deductibles and coinsurance amounts not paid by the program
are often called: - Answer-Medigap plans
A private organization such as another medical insurance company that contracts with the federal
government to pay hospital claims in a region is called a fiscal intermediary. - Answer-True
Post payment Medicare audits are triggered most frequently by patient complaints. - Answer-False
This "part" of the traditional Medicare program helps beneficiaries pay for prescription drugs. - Answer-
Part D
Medicare beneficiaries covered under the original Part A and Part B coverage do not have to pay an
annual deductible. - Answer-False (there is a part A deductible for hospital admission for every spell of
illness and one annual part B deductible)
The managed care option of the Medicare program is: - Answer-Part C
This is the term used when Medicare is not responsible for paying first because coverage under another
insurance policy, like a employer large group plan, is required: - Answer-Medicare Secondary Payer
Providers who do not participate in the Medicare program can bill patients for the non-allowed amount
up to the limiting charge determined by the program. - Answer-True
The amount that Medicare and Medicaid will pay for a service provided to a beneficiary is called the: -
Answer-allowed amount
In the Medicare program, the notice the patient receives describing how the claim was adjudicated and
paid is called an Advance Beneficiary Notice. - Answer-False
When a service or procedure meets Medicare's or Medicaid's criteria for coverage and payment, it is
said to be: - Answer-medically necessary
A private organization, usually another medical insurance company, that contracts with the federal
government to adjudicate and pay Medicare Part B claims in a region is called a: - Answer-carrier
This "part" of the traditional Medicare program pays for inpatient hospital care, home health care, and
skilled nursing care. - Answer-Part A
The Medicare Part B coinsurance is 70% of allowed charges after the annual Part B deductible has been
met. - Answer-False
The difference between what the provider charges and the basis on which Medicare or Medicaid will
pay is called the: - Answer-contractual adjustment
When a Medicaid beneficiary has no other health care coverage, the type of claim that is submitted is
called a: - Answer-Medicaid simple claim
When one state allows Medicaid beneficiaries to be treated in an adjacent state, it is referred to as: -
Answer-reciprocity
,After verifying the Medicaid patient's name and demographic information against their Medicaid card
and picture ID, always check this before providing service: - Answer-their current period of eligibility
The Medicare and Medicaid programs are administered by this federal agency: - Answer-CMS
Medically needy individuals can reduce their assets to the Medicaid eligibility level by using assets to pay
for medical care in a process called: - Answer-spend down
When an individual is covered under both Medicaid and Medicare and/or a private health care policy,
Medicaid is always the "payer of last resort". - Answer-True
All Medicaid plans are strictly fee-for-service and managed care types of programs do not exist with
state Medicaid programs. - Answer-False
When Medicare automatically forwards claim and payment information to the supplemental insurance
plan, such as Medicaid, the process is called a: - Answer-crossover
This "part" of the traditional Medicare program pays for physician services, outpatient services, and
durable medical equipment: - Answer-Part B
Medicaid eligibility should be verified every single time the Medicaid patient arrives for services. -
Answer-True
Local Coverage Determinations focus on the types of medical services individual Medicare contractors
agree to cover. - Answer-False
Once a patient qualifies for Medicaid, they remain eligible for life. - Answer-False
In order to qualify for Medicaid, an individual must be categorically or medically needy. - Answer-True
, The Part B premium is usually deducted from the beneficiary's monthly social security check. - Answer-
True
Medicare supplemental plans that cover deductibles and coinsurance amounts not paid by the program
are often called: - Answer-Medigap plans
A private organization such as another medical insurance company that contracts with the federal
government to pay hospital claims in a region is called a fiscal intermediary. - Answer-True
Post payment Medicare audits are triggered most frequently by patient complaints. - Answer-False
This "part" of the traditional Medicare program helps beneficiaries pay for prescription drugs. - Answer-
Part D
Medicare beneficiaries covered under the original Part A and Part B coverage do not have to pay an
annual deductible. - Answer-False (there is a part A deductible for hospital admission for every spell of
illness and one annual part B deductible)
The managed care option of the Medicare program is: - Answer-Part C
This is the term used when Medicare is not responsible for paying first because coverage under another
insurance policy, like a employer large group plan, is required: - Answer-Medicare Secondary Payer
Providers who do not participate in the Medicare program can bill patients for the non-allowed amount
up to the limiting charge determined by the program. - Answer-True
The amount that Medicare and Medicaid will pay for a service provided to a beneficiary is called the: -
Answer-allowed amount
