Deck 14: Medicare

Question 1

Which program helps individuals whose assets are not low enough to qualify them for Medicaid by requiring states to pay their Medicare Part A and B premiums, deductibles, and coinsurance amounts?

A) qualified Medicare beneficiary program
B) qualified disabled working individual
C) qualifying individual
D) specified low-income Medicare beneficiary

Answer 1

qualified Medicare beneficiary program

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.

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

Answer 2

Parts A and B

Question 3

Individuals who wait until they turn 65 to apply for Medicare will cause a delay in the start of Part B coverage, because they will have to wait until the next __________ enrollment period, which is held January 1 through March 31 of each year, with Part B coverage starting on July 1 of that year.

A) beneficiary
B) general
C) initial
D) special

Answer 3

general

Question 4

Medicare lifetime reserve days, which total __________ days, are used once during a patient's lifetime and are usually reserved for use during the patient's final, terminal hospital stay.

A) 30
B) 60
C) 90
D) 120

Question 5

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

A) home health care
B) hospice care
C) hospital care
D) respite care

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 __________.

A) Medicaid
B) Medicare PLUS
C) Medigap
D) PACE

Question 7

Which program pays for inpatient hospital critical care access, skilled nursing facility stays, hospice care, and some home health care?

A) Medicare Part A
B) Medicare Part B
C) Medicare Part C
D) Medicare Part D

Question 8

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

A) CMS-1500
B) CMS-1500 or UB-04
C) CMS-1500 and UB-04
D) UB-04

Question 9

Which program includes managed care and private fee-for-service plans that provide contracted care to Medicare patients?

A) Medicare Part A
B) Medicare Part B
C) Medicare Part C
D) Medicare Part D

Question 10

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

A) CMS-1500
B) CMS-1500 or UB-04
C) UB-92
D) UB-04

Question 11

A Medicare benefit period begins with the first day of hospitalization and ends when the patient has been out of the hospital for __________ consecutive days.

A) 10
B) 30
C) 60
D) 90

Question 12

Which program helps individuals who received Social Security and Medicare because of disability, but who lost their Social Security benefits and free Medicare Part A because they returned to work and their earnings exceed the limit allowed, by requiring states to pay their Medicare Part A premiums?

A) qualified Medicare beneficiary program
B) qualified disabled working individual
C) qualifying individual
D) specified low-income Medicare beneficiary

Question 13

Which program added prescription medication coverage to the original Medicare plan, some Medicare cost plans, some Medicare private fee-for-service plans, and Medicare medical Savings Account Plans?

A) Medicare Part A
B) Medicare Part B
C) Medicare Part C
D) Medicare Part D

Question 14

Which program helps low-income individuals by requiring states to pay their Medicare Part B premiums?

A) qualified Medicare beneficiary program
B) qualified disabled working individual
C) Programs of All-Inclusive Care for the Elderly
D) specified low-income Medicare beneficiary

Question 15

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.

A) 50
B) 80
C) 100
D) 115

Question 16

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

A) CMS-1450
B) CMS-1500
C) UB-92
D) UB-04

Question 17

Which is an autonomous, centrally administered program of coordinated inpatient and outpatient palliative (relief of symptoms) services for terminally ill patients and their families?

A) home health
B) hospice
C) hospital
D) respite

Question 18

Mary Smith is working full time and enrolled in Medicare Part A at age 65. She decided not to enroll in Medicare Part B at that time because her employer group health insurance coverage reimburses for physician and other outpatient encounters. Mary is eligible to enroll in Medicare Part B anytime during a(n) __________ enrollment period, which is a set time when individuals can sign up for Medicare Part B if they did not enroll when they applied for Medicare Part A.

A) beneficiary
B) general
C) initial
D) special

Question 19

Which program pays for physician services, outpatient hospital care, and durable medical equipment?

A) Medicare Part A
B) Medicare Part B
C) Medicare Part C
D) Medicare Part D

Question 20

An initial enrollment period (IEP) that provides an opportunity for the individual to enroll in Medicare Part A and/or Part B is for a period of __________ months.

A) 3
B) 6
C) 7
D) 9

Question 21

The Balanced Budget Act of 1997 allows certain health care providers to withdraw from Medicare and enter into private contracts with their Medicare patients, which requires "opting out" of Medicare for at least __________ years for all covered items and services furnished to Medicare beneficiaries.

A) 2
B) 4
C) 6
D) 8

Question 22

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.

A) durable medical equipment
B) PPV and influenza virus vaccination
C) preventive care and screening
D) well baby and well child care

Question 23

Medicare __________ is a type of Medigap insurance that requires enrollees to use a network of providers to receive full benefits, which may result in lower premiums for enrollees.

A) PACE
B) PLUS
C) SELECT
D) SUPPLEMENT

Question 24

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.

A) Medicare Advantage
B) Medicare Cost Plan
C) Medicare Supplementary Insurance
D) Medicare SELECT

Question 25

A Medicare-Medicaid (Medi-Medi) crossover plan provides both Medicare and Medicaid coverage to __________ beneficiaries with low incomes.

A) Medicaid
B) Medicare
C) Medigap
D) TRICARE

Question 26

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

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 reimbursed

Question 27

An advance beneficiary notice of noncoverage (ABN) is a written document provided to a Medicare beneficiary by a supplier, physician, or provider, and the ABN must be presented to the patient __________.

A) after Medicare has denied payment for the service
B) at least one month before providing the service
C) on the day the service or treatment is provided
D) prior to providing the service or treatment

Question 28

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

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

Question 29

Which is a combination Medicare and Medicaid option that combines medical, social, and long-term care services for frail people who live and receive health care in the community?

A) Medicare SELECT
B) PACE
C) QMBP
D) SLMB