NC MEDICARE SUPPLEMENT LONG TERM CARE
CORRECT FINAL EXAM QUESTIONS AND
ANSWERS SURE A+
✔✔Medicare & the VA - ✔✔Can choose to get treatment under either plan. Medicare
usually will not pay benefits if services are rendered in a VA facility but will pay if outside
of VA. There is NO coordination between Federal agencies.
✔✔Expenses NOT paid by Medicare - ✔✔-Purely custodial care/ chronic care
-Services that are not reasonable or medically necessary under Medicare standards
-Services performed by relatives/ member of beneficiary's household
-Services paid for by another gov't agency
✔✔Medicare Part A covers - ✔✔-acute inpatient hospital care
-inpatient skilled nursing care
-medically necessary home health care & hospice services
✔✔Medicare Deductible - ✔✔-Deductible must be met for ea. benefit period
-Benefit period ends 60 days after discharge
-Deductible is $1364 plus need to pay/ replace first 3 pts of blood per calendar year.
✔✔Days 1 to 60 - ✔✔Non-Exhaustible Benefit
, -After deductible is met, Part A pays 100% of all approved hospital charges for first 60
days of confinement.
✔✔From day 61 to 90th day of confinement - ✔✔Part A will pay 100% of approved
charges less a copay of 25% of current deductible ($341) per day.
-Also a non-exhaustible benefit
✔✔60 day Lifetime Hospital Reserve Benefit - ✔✔Reserve days may be used after pt
has been hospitalized for > 90days
-Exhaustible Benefit
-Will no longer be available once it's been used.
-Pays 100% less a daily copay of $682 equivalent of 50% of current deductible.
✔✔benefit period (Medicare) - ✔✔begins with the first day of hospitalization and ends
when the patient has been out of the hospital for 60 consecutive days.
✔✔Non-Exhaustible Benefit - ✔✔for each separate benefit period is 90 days with an
exhaustible 60 day lifetime reserve.
-Medicare no longer pays hospital expenses during that benefit period after lifetime
reserves are exhausted.
✔✔Inpatient Medicare Benefits - ✔✔-Hospitalization is prescribed by a physician to treat
acute illness or accident
-Level of care care only be received as an inpatient.
-Facility must be certified by CMS & licensed by state
-Utilization Review Committee must certify that treatment given in medically necessary
before claim is submitted.
✔✔PPS (Prospective Payment System) - ✔✔fixed payment scale/schedule based on
your DRG (diagnosis related group) which is assigned at admission.
✔✔DRG (Diagnosis Related Group Classification) - ✔✔-Patient is assigned to a
Diagnosis Related Group (DRG) upon admission & that is the scheduled benefit
payment that will be provided to the hospital regardless of the actual duration of
confinement
-Hospital must accept this benefit payment as payment in full for the time period
approved by the DRG (Approved Charges)
✔✔QIO (Quality Improvement Organization) - ✔✔A private organization composed of
practicing physicians and other health care professionals in each state that is paid by
the Centers for Medicare & Medicaid Services under contract to review the care
provided to Medicare beneficiaries.
✔✔Medicare & inpatient psychiatric care - ✔✔Part A will pay benefits for a max of 190
days for inpatient psych care. Lifetime Maximum.
CORRECT FINAL EXAM QUESTIONS AND
ANSWERS SURE A+
✔✔Medicare & the VA - ✔✔Can choose to get treatment under either plan. Medicare
usually will not pay benefits if services are rendered in a VA facility but will pay if outside
of VA. There is NO coordination between Federal agencies.
✔✔Expenses NOT paid by Medicare - ✔✔-Purely custodial care/ chronic care
-Services that are not reasonable or medically necessary under Medicare standards
-Services performed by relatives/ member of beneficiary's household
-Services paid for by another gov't agency
✔✔Medicare Part A covers - ✔✔-acute inpatient hospital care
-inpatient skilled nursing care
-medically necessary home health care & hospice services
✔✔Medicare Deductible - ✔✔-Deductible must be met for ea. benefit period
-Benefit period ends 60 days after discharge
-Deductible is $1364 plus need to pay/ replace first 3 pts of blood per calendar year.
✔✔Days 1 to 60 - ✔✔Non-Exhaustible Benefit
, -After deductible is met, Part A pays 100% of all approved hospital charges for first 60
days of confinement.
✔✔From day 61 to 90th day of confinement - ✔✔Part A will pay 100% of approved
charges less a copay of 25% of current deductible ($341) per day.
-Also a non-exhaustible benefit
✔✔60 day Lifetime Hospital Reserve Benefit - ✔✔Reserve days may be used after pt
has been hospitalized for > 90days
-Exhaustible Benefit
-Will no longer be available once it's been used.
-Pays 100% less a daily copay of $682 equivalent of 50% of current deductible.
✔✔benefit period (Medicare) - ✔✔begins with the first day of hospitalization and ends
when the patient has been out of the hospital for 60 consecutive days.
✔✔Non-Exhaustible Benefit - ✔✔for each separate benefit period is 90 days with an
exhaustible 60 day lifetime reserve.
-Medicare no longer pays hospital expenses during that benefit period after lifetime
reserves are exhausted.
✔✔Inpatient Medicare Benefits - ✔✔-Hospitalization is prescribed by a physician to treat
acute illness or accident
-Level of care care only be received as an inpatient.
-Facility must be certified by CMS & licensed by state
-Utilization Review Committee must certify that treatment given in medically necessary
before claim is submitted.
✔✔PPS (Prospective Payment System) - ✔✔fixed payment scale/schedule based on
your DRG (diagnosis related group) which is assigned at admission.
✔✔DRG (Diagnosis Related Group Classification) - ✔✔-Patient is assigned to a
Diagnosis Related Group (DRG) upon admission & that is the scheduled benefit
payment that will be provided to the hospital regardless of the actual duration of
confinement
-Hospital must accept this benefit payment as payment in full for the time period
approved by the DRG (Approved Charges)
✔✔QIO (Quality Improvement Organization) - ✔✔A private organization composed of
practicing physicians and other health care professionals in each state that is paid by
the Centers for Medicare & Medicaid Services under contract to review the care
provided to Medicare beneficiaries.
✔✔Medicare & inpatient psychiatric care - ✔✔Part A will pay benefits for a max of 190
days for inpatient psych care. Lifetime Maximum.
