Medicare Certification Questions and Answers (True/False) 2023

Medicare Certification Questions and Answers (True/False) 2023 T/F: When Medicare began in July 1, 1966, it was the primary payer for all beneficiaries except for those who had benefits from Large Group Health Plans (LGHPs). - False T/F: For diagnostic tests provided to Part A beneficiaries that are split into technical component and a professional component, both components are subject to Skilled Nursing Facility Consolidated Billing. - False T/F: A physician is an example of a provider that submits claims for Part B services. - True T/F: It is a violation of the Physician Self Referral Act for a physician to refer to a Medicare beneficiary for certain Designated Health Services (DHS) to a business owned by his/her spouse. - True T/F: All beneficiaries are automatically enrolled in a Medicare Prescription drug plan when they become eligible for Medicare - False T/F: Three punctuation symbols listed in the official ICD-9-CM guidelines are brackets, parentheses, and commas. - False Denial or revocation of Medicare billing privileges, suspension of provider payments, and application of Civil Monetary Penalties (CMPs) are all examples of ________________. - administrative sanctions T/F: People in the Original Medicare Plan can get prescription drug coverage by either joining a Medicare Prescription Drug Plan or selecting a Medigap policy that includes prescription drug coverage. - False T/F: Medicare requires a health care professional to give an Advance Beneficiary Notice (ABN) of Noncoverage to a beneficiary after a service is provided but prior to building. - False Medicare beneficiaries with End-Stage Renal Disease (ESRD) and Group Health Plan (GHP) coverage will have Medicare as the primary payer after the ____________ coordination period has elapsed. - 30-month T/F: The first step of the Medicare Electronic Data Interchange (EDI) process is to review Remittance Advice (RA). - False Condition codes, revenue codes, and occurrence codes are examples of __________ Health Insurance Portability and Accountability Act (HIPAA) standard code sets. - Non-medical T/F: Terms listed under certain four- and five-digit diagnosis codes are called Inclusion Terms. These terms are conditions for which a diagnosis code number is to be used. - True T/F: CMS enterprise applications will NOT allow providers to determine beneficiary payment responsibility with regard to deductible/copayment/coinsurance. - False Which Health Insurance Portability and Accountability Act (HIPAA) standard transaction will you use to check the status of a claim? ASC X12N ___________ - 270/271 Field 24E on FOrm CMS-1500 contains the most significant reason for the visit or encounter. What field is this? - diagnosis code T/F: The Original Medicare Plan includes Part A and Part B. - False A beneficiary's red, white and blue Medicare card indicates whether he/she has enrolled in a Medicare Advantage (MA) Plan. - False T/F: "Percentage of the total body with first-degree burns" is one of the four basic elements when diagnosis coding for burns. - False Which Health Insurance Portability and Accountability Act (HIPAA) standard transaction will you use to inquire about a beneficiary's eligibility or coverage? ASC X12N ________ - 278 Development Questionnaires are used to determine if there are any additional ______________ for health care services. - papers to be filed T/F: The Medical Review (MR) Program identifies and addresses billing errors through the following: identifying potential billing errors concerning coverage and coding; profiling of providers, services, and/or beneficiary utilization; evaluation of complaints, enrollment, and/or cost report data; and data analysis. - True