Question 1

A Medicare medical necessity denial is a denial of otherwise covered services that were found to be not __________.

Accepted Answer

A)   cost effective and necessary
B)   in compliance with critical pathways
C)   necessary and frequent
D)   reasonable and necessaryE) A) and D)
F) B) and D)

Question 2

Medicare special needs plans cover all Medicare __________ health care services for individuals who can benefit the most from special care for chronic illnesses, care management of multiple diseases, and focused care management.

Accepted Answer

A)   Part A only
B)   Part B only
C)   Parts A and B
D)   Parts A, B and DE) B) and C)
F) B) and D)

Question 3

Which is the term for short-term care provided by another caregiver, so the usual caregiver can rest?

Accepted Answer

A)   home health care
B)   hospice care
C)   hospital care
D)   respite careE) A) and C)
F) C) and D)

Question 4

Medicare will award an assigned claim conditional primary payer status and process the claim when a __________.

Accepted Answer

A)   patient who is physically or mentally impaired files a claim with the primary payer
B)   plan considered primary to Medicare issues a denial of payment that is under appeal
C)   liability payer responds by processing a submitted claim within 120 days of filing
D)   workers' compensation claim has been approved and the provider reimbursedE) B) and C)
F) A) and B)

Question 5

Private fee-for-service (PFFS)  plans are offered by private insurance companies in some regions of the country, and Medicare pays a pre-established amount of money each month to the insurance company, which decides how much it will pay for services. Such plans reimburse providers on a fee-for-service basis and are authorized to charge enrollees up to __________ percent of the plan's payment schedule.

Accepted Answer

A)   50
B)   80
C)   100
D)   115E) A) and B)
F) A) and C)

Question 6

Medicare beneficiaries can also obtain supplemental insurance to help cover costs not reimbursed by the original Medicare plan. This type of coverage is called __________.

Accepted Answer

A)   Medicaid
B)   Medicare PLUS
C)   Medigap
D)   PACEE) None of the above
F) A) and B)

Question 7

Which is a type of HMO that works in much the same way and has some of the same rules as a Medicare Advantage Plan, except that the individual receives health care from a non-network provider, and the original Medicare plan covers the services? The individual pays Medicare Part A and Part B coinsurance and deductibles.

Accepted Answer

A)   Medicare Advantage
B)   Medicare Cost Plan
C)   Medicare Supplementary Insurance
D)   Medicare SELECTE) None of the above
F) A) and B)

Question 8

Which insurance claim is submitted to receive reimbursement under Medicare Part C?

Accepted Answer

A)   CMS-1500
B)   CMS-1500 or UB-04
C)   UB-92
D)   UB-04E) None of the above
F) C) and D)

Question 9

A simplified roster billing process was developed to enable Medicare beneficiaries to participate in mass __________ programs offered by public health clinics and other entities that bill Medicare payers.

Accepted Answer

A)   durable medical equipment
B)   PPV and influenza virus vaccination
C)   preventive care and screening
D)   well baby and well child careE) All of the above
F) None of the above

Exam 14: Medicare

A simplified roster billing process was developed to enable Medicare beneficiaries to participate in mass __________ programs offered by public health clinics and other entities that bill Medicare payers.

Correct Answer
verified

A Medicare medical necessity denial is a denial of otherwise covered services that were found to be not __________.

Correct Answer
verified

Which insurance claim is submitted to receive reimbursement under Medicare Part C?

Correct Answer
verified

Correct Answer
verified

Medicare beneficiaries can also obtain supplemental insurance to help cover costs not reimbursed by the original Medicare plan. This type of coverage is called __________.

Correct Answer
verified

Medicare will award an assigned claim conditional primary payer status and process the claim when a __________.

Correct Answer
verified

Medicare special needs plans cover all Medicare __________ health care services for individuals who can benefit the most from special care for chronic illnesses, care management of multiple diseases, and focused care management.

Correct Answer
verified

Correct Answer
verified

Which is the term for short-term care provided by another caregiver, so the usual caregiver can rest?

Correct Answer
verified

Exam 14: Medicare

A simplified roster billing process was developed to enable Medicare beneficiaries to participate in mass __________ programs offered by public health clinics and other entities that bill Medicare payers.

Correct AnswerverifiedShow Answer

A Medicare medical necessity denial is a denial of otherwise covered services that were found to be not __________.

Correct AnswerverifiedShow Answer

Which insurance claim is submitted to receive reimbursement under Medicare Part C?

Correct AnswerverifiedShow Answer

Correct AnswerverifiedShow Answer

Medicare beneficiaries can also obtain supplemental insurance to help cover costs not reimbursed by the original Medicare plan. This type of coverage is called __________.

Correct AnswerverifiedShow Answer

Medicare will award an assigned claim conditional primary payer status and process the claim when a __________.

Correct AnswerverifiedShow Answer

Medicare special needs plans cover all Medicare __________ health care services for individuals who can benefit the most from special care for chronic illnesses, care management of multiple diseases, and focused care management.

Correct AnswerverifiedShow Answer

Correct AnswerverifiedShow Answer

Which is the term for short-term care provided by another caregiver, so the usual caregiver can rest?

Correct AnswerverifiedShow Answer

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified