Medicare supplement/LTC NC Exam Questions With Correct Answers

Medicare - Answer A federal program of health insurance for persons 65 years of age and older Medicare is run by - Answer Centers for Medicare and Medicaid services of the department of health and human services Medicare parts A & B are - Answer Referred to as original Medicare Medicare Part A(Inpatient) is funded - Answer By the hospital insurance portion of the FICA payroll tax collected from workers and employers. Also by the premiums paid by individuals who aren't automatically covered by medicare but wish to purchase it. This also pays for Medicare part A - Answer Taxes paid on Social Security benefits Medicare part B is funded - Answer Partially by general tax revenues and partially by premiums paid to the federal government by Medicare part B beneficiaries Part B beneficiary must - Answer Must pay a premium for coverage on like Part a Most part B beneficiaries pay - Answer The standard part B premium which may be adjusted each year for inflation What is the threshold Part B beneficiaries have to a seed for a higher premium? - Answer $85,000 for single people and $170,000 for married couples filing jointly Medicare Savings Program - Answer A state run programs some low income individuals may qualify for that assist with paying the cost of Medicare coverage Qualified Medicare beneficiary(QMB) program - Answer A program for those whose monthly income is no more than the federal poverty level plus $20. Helps pay the part B premium and may also help pay a beneficiary's part a premium , Deductibles, coinsurance, and copayments Specified low-income Medicare beneficiary (SLMB) - Answer To qualify, a persons Monthly be income is no more than 120% of the federal poverty level plus $20. This program only pays for the part B premium no other Medicare costs qualifying individual (QI) - Answer To qualify a persons monthly income is no more than 135% of the federal Poverty level Plus $20. This program helps pay for only the part B premium Medicare part C is referred to as - Answer Medicare advantage Medicare Advantage is - Answer A combination of part a and part B coverage plus additional benefits not covered by original Medicare such as hearing or vision care Medicare part D is funded - Answer Partially by general tax revenues and partially by premiums paid by part the beneficiaries... Like part B Medicare part B premiums are - Answer Pay to the provider of the part D plan rather than the federal government unlike part B To be eligible to enroll in Medicare individuals must be - Answer Age 65 or older, social security disability beneficiaries (Generally after two years) Are suffering from end-stage renal disease Enrollment in Medicare part a and B is automatic for - Answer People who are already receiving Social Security benefits For people covered by Social Security - Answer Part A is premium free but part B is not. Individuals automatically enroll in part B have the option to drop it if they don't want to pay the premium The late enrollment penalty for part B plans is - Answer And additional charge of 10% of the part B premium for every 12 months that has passed since their eligibility for Medicare. initial enrollment period (IEP) - Answer For Medicare is a seven month. That includes the month someone's birthday occurs and the three months on either side general enrollment period (GEP) - Answer The designated enrollment period from January 1 through March 31 each year for those who missed their initial enrollment. The coverage does not become effective until July 1 special enrollment period (SEP) - Answer A currently employed individual who is still insured under a group health plan when he or she reaches age 65 can either enroll into Medicare while still covered by his or her group health plan, or defer Medicare enrollment until he or she retires. Once employer group health coverage has ended, a retiree enters a Special Enrollment Period (SEP) in which he or she has 8 months to enroll into Parts A and B without being charged late Part A and Part B enrollment penalties. open enrollment period - Answer The time period from October 15 until December 7 one can make changes to their Medicare coverage. -change from original Medicare to a Medicare advantage plan, or Vice versa -switch from one Medicare advantage plan to another -Obtain, change or drop their Medicare part D For working Medicare beneficiaries also covered by employer group health plans - Answer If the employer has less than 20 employees Medicare pays first. 20 or more employees, the employers group health plan pays first Prospective payment systems - Answer A federal government system introduced two Chainz hospital behavior through financial incentives and encourage more cost efficient delivery of medical care. Hospitals are paid a predetermined rate for each Medicare admission based on the diagnosis related groups (DRG) Diagnosis-related groups (DRGs) - Answer A system of analyzing conditions and treatments for similar groups of patients used to establish Medicare fees for hospital inpatient services; patients are classified by their principal diagnosis, surgical procedure, age, and other factors. Quality improvement organization - Answer A private, generally not for profit organization staffed mostly by doctors and other healthcare professionals, used to help improve services while controlling costs. CMS contracts with one firm in each state Core functions of the QIO program are: - Answer -Improving quality of care for beneficiaries -protecting the integrity of the Medicare trust fine by ensuring Medicare pays only for services and goods that are reasonable and necessary -addressing individual complaints such as: beneficiary complaints, provider-based notice appeals, violations of the EMTALA Utilization review committee - Answer A medical committee that evaluates the appropriateness of admissions, treatment and length of stay and reviews the various resources used in providing care. If the URC determines That a Medicare beneficiary does not need to be admitted or, I meant to stay in the facility - Answer They must notify the patient, the practitioner, and the hospital within two days after the determination. If the URC reviews an outlier case they must do so no later than seven days after the DRG limits have been reached Medicare Administrative Contractor (MAC) - Answer Processes Medicare Parts A and B claims from hospitals, physicians, and other providers.