NC Medicare Supplement & Long Term Care Insurance
Licensing Exam 2025/2026 Actual Complete Real Exam
Questions And Correct Answers (Verified Answers) |
Already Graded A+ / Latest Exam!!
Inpatient Medicare Benefits - ANSWER--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) - ANSWER-fixed payment
scale/schedule based on your DRG (diagnosis related group)
which is assigned at admission.
DRG (Diagnosis Related Group Classification) - ANSWER--
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) - ANSWER-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 - ANSWER-Part A will
pay benefits for a
max of 190 days for inpatient psych care.
Lifetime Maximum.
What Medicare Part A covers - ANSWER--Semi-private room,
Routine nursing services
-ICU, CCU & other special care units
-All meals including special diets
-Drugs administered inpatient
-Blood transfusions after 3 pts deductible
-OR & recovery room charges
-Ancillary items charged by hospital e.g. dressings, casts
-Pathology reports, lab exams charged by hospital
-Hospital charges for anesthesia services
-Radiology charges by hospital including radiation therapy
-Rehab services of hospital incl. physical, occupational &
speech therapy -Ambulatory devices provided by hospital incl.
crutches, wheelchairs
Medicare Part A does not cover - ANSWER--Hospital stays >150
days for first benefit period or no longer than 90 days after
using up lifetime reserve
-Private rooms unless medically necessary
-Physician's or surgeon's fees (Medicare Part B)
-Luxury or convenience items rented from hospital
, -Private duty nursing
-Tests or exams conducted/ billed by 3rd party or similar
hospital charges incurred on outpatient basis.
-Inpatient psych care of > 190 days during lifetime
Skilled Nursing Facility (SNF) & Medicare - ANSWER-Part A will
cover if hospitalized at least 3 days & is then admitted to SNF
within 30 days of stay in order to maintain continuum of care
for same/ related condition.
-SNF must be certified by CMS and have 24h nurse on duty.
-Days 1-20 - Part A will pay all approve costs for first 20d of
each benefit period -Days 21 to 100 - Part A will pay all costs
except for 12.5% (1/8) of current deductible as copay.
-Over 100 days - No benefit will be provided for that benefit
period.
Levels of Nursing Home Care -
ANSWER-Skilled
Intermediate
Custodial
Medicare only pays for skilled care
Home Health Care - ANSWER-Individual must be confined to
home & under
care of physician who has establish a necessary home
health care plan.
-Prior hospitalization not
required
Licensing Exam 2025/2026 Actual Complete Real Exam
Questions And Correct Answers (Verified Answers) |
Already Graded A+ / Latest Exam!!
Inpatient Medicare Benefits - ANSWER--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) - ANSWER-fixed payment
scale/schedule based on your DRG (diagnosis related group)
which is assigned at admission.
DRG (Diagnosis Related Group Classification) - ANSWER--
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) - ANSWER-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 - ANSWER-Part A will
pay benefits for a
max of 190 days for inpatient psych care.
Lifetime Maximum.
What Medicare Part A covers - ANSWER--Semi-private room,
Routine nursing services
-ICU, CCU & other special care units
-All meals including special diets
-Drugs administered inpatient
-Blood transfusions after 3 pts deductible
-OR & recovery room charges
-Ancillary items charged by hospital e.g. dressings, casts
-Pathology reports, lab exams charged by hospital
-Hospital charges for anesthesia services
-Radiology charges by hospital including radiation therapy
-Rehab services of hospital incl. physical, occupational &
speech therapy -Ambulatory devices provided by hospital incl.
crutches, wheelchairs
Medicare Part A does not cover - ANSWER--Hospital stays >150
days for first benefit period or no longer than 90 days after
using up lifetime reserve
-Private rooms unless medically necessary
-Physician's or surgeon's fees (Medicare Part B)
-Luxury or convenience items rented from hospital
, -Private duty nursing
-Tests or exams conducted/ billed by 3rd party or similar
hospital charges incurred on outpatient basis.
-Inpatient psych care of > 190 days during lifetime
Skilled Nursing Facility (SNF) & Medicare - ANSWER-Part A will
cover if hospitalized at least 3 days & is then admitted to SNF
within 30 days of stay in order to maintain continuum of care
for same/ related condition.
-SNF must be certified by CMS and have 24h nurse on duty.
-Days 1-20 - Part A will pay all approve costs for first 20d of
each benefit period -Days 21 to 100 - Part A will pay all costs
except for 12.5% (1/8) of current deductible as copay.
-Over 100 days - No benefit will be provided for that benefit
period.
Levels of Nursing Home Care -
ANSWER-Skilled
Intermediate
Custodial
Medicare only pays for skilled care
Home Health Care - ANSWER-Individual must be confined to
home & under
care of physician who has establish a necessary home
health care plan.
-Prior hospitalization not
required
