Medicare - Certification Exam || Already Graded A+.

Medicare Part B correct answers Financed by the Supplementary Medical Insurance (SMI) Trust Fund, which is funded through general tax revenue and premiums paid by benefit recipients. Assignment correct answers If a doctor has accepted a Medicare assignment, the doctor will bill the patient directly. The patient then fills out a Medicare claim form and attaches the itemized bills from the doctor. These providers are known as Non-participating providers or suppliers. Non-participating providers have the option of accepting Medicare assignment or can charge no more than 15% above Medicare approved charge (known as the limiting charge). Appeals correct answers To appeal, send a copy of the Medicare Summary Notice (MSN) for the service or prescription in question to Medicare within 120 days. Fast appeals may be made by contacting the local Quality Improvement Organization. Determining the Payor correct answers Medicare is the Primary Payor, meaning they are responsible for claims first: -If the individual is retired, even if they have coverage through an employer o runion. -Starting month 31 if an individual has ESRD and also has group coverage. Medicare is the Secondary Payor, meaning someone else is responsible for claims first: - If the individual is currently employed and insured by either their employer or their spouse's employer coverage. -For the first 30 months an individual has ESRD if they also have group coverage through an employer or union. -To "no-fault" insurance, liability, black lung benefits, and workers' compensation. Subrogation correct answers Subrogation allows Medicare to pay for services and then recoup that payment from another responsible party. This is most commonly used when workers compensation or a primary insurance plan does not make an immediate payment. Medicare pays the claim to prevent the beneficiary from using their own money to pay a medical bill or being denied treatment. The payment is considered conditional because it must be repaid to Medicare either by workers compensation, the primary insurer, or another responsible payer. Medicare Administration correct answers Medicare is administered by the center for Medicare and Medicaid Services (CMS). The CMS contracts with intermediaries, private regional organizations who act as the middle man and enroll providers, process Medicare claims, and investigate fraud. Who establishes regional policy guidelines? correct answers MACs establish regional policy guidelines, called Local Coverage Determinations (LCSDs).