CMS IS SHORT FOR
CENTERS FOR MEDICARE AND MEDICAID SERVICES
CENTERS FOR MEDICAID AND MEDICARE SERVICES
SERVICES FOR MEDI-MEDI SERVICES
CENTERS FOR MEDICARE SERVICES
MEDICAID IS ADMINISTERED BY
CMS
TMHP
MCS
CNS
MEDICARE PART A IS FOR
PROVIDER SERVICES
OUTPATIENT SERVICES
HOSPITAL SERVICDES
DME SERVICES
MEDICARE IS A ____________ PROGRAM
STATE
LOCAL
FEDERAL
STATE/FEDERAL
OVER THE PERIOD OF _________ YEARS, DEPARTMENT OF HEALTH AND HUMAN SERVICES WILL DISTRIBUTE REPLACEMENT CARDS TO MEDICARE BENEFICIARIES
6-4
7-8
4-8
3-4
IF A CARD SHOWS HMO, THEN THE PATIENT SIGNED UP AND IS COVERED BY A ____
PRIVATE INSURANCE
PREFERRED PROVIDER ORGANIZATION
MANAGED CARE PLAN
TRADITIONAL FEE FOR SERVICE
THE LETTER C IDENTIFIES THAT THE INSURED IS THE
WIDOW
SPOUSE
BENEFICIARY
DISABLED CHILD
A RAILROAD MEDICARE BENEFICIARY IDENTIFICATION NUMBER BEGINS WITH A
NUMBER OR NUMBERS
LETTER OR LETTERS
POUND SIGN
SPECIAL CHARACTER
UNDER MEDICARE PART____, IF AN INDIVIDUAL RECEIVING SOCIAL SECURITY OR RAILROAD RETIREMENT BENEFITS DID NOT SIGN UP FOR MEDICARE AT THE TIME OF ELIGIBILITY, THEN THE INDIVIDUAL IS ELIGIBLE TO ENROLL IN MEDICARE 3 MONTHS BEFORE HIS OR HER BIRTHDAY
A
B
C
D
ESRD IS SHORT FOR
EVEN STAGE RENAL DISORDERS
END STATE RENAL DISEASE
END SPECIAL RENAL DISEASE
END STATES RENAL DISEASES
MEDICARE PART B HAS AN ANNUAL ______ THAT CONTINUES TO INCREASE BY THE SOCIAL SECURITY ADMINISTRATION
COPAYMENT
PREAUTHORIZATION
CO-INSURANCE
PREMIUM
MEDICARE PART ___ IS COMMONLY REFERRED AS MEDICARE ADVANTAGE PLAN
MEDICARE PART D IS FOR PRESCRIPTION COVERAGE AND MOST OF THE MEDICARE DRUG PLANS HAVE COVERAGE GAP KNOWN AS
GAP
LAPSE IN COVERAGE
DONUT HOLE
FORMELY
MEDICAL INSURANCE FOR RAILROAD RETIREMENT BENEFITS PREMIUMS ARE AUTOMATICALLY DEDUCTED FROM
EMPLOYER PAYCHECKS
MONTHLY CHECKS RECEIVED OF PEOPLE WHO RECEIVE RAILROAD RETIREMENT
FROM THE BENEFICIARY'S CHECKING ACCOUNT
THE BENEFICIARY'S SAVINGS ACCOUNT
MEDICARE SECONDARY PAYER (MSP) DEFINES MEDICARE TO BE
PRIMARY PAYER
SECONDARY PAYER
PAYER OF LAST RESORT
TERTIARY PAYER
A ________ IS A LIST OF THE DRUGS THAT A PLAN COVERS
FORMULARY
LIST OF APPROVED DRUGS
MEDICARE PRESCRIPTIONS DRUG COVERAGE
TIER ONE LIST
MEDICARE MAKES PAYMENTS DIRECTLY TO THE _______ ON A MONTHLY BASIS FOR MEDICARE ENROLLEES WHO USE THE HMO OPTION
PATIENT
PROVIDER
HMO
PPO
MEDICARE ADVANTAGE PLANS (HMO'S OR PPO'S) HAVE AN OPEN ENROLLMENT PERIOD IN THE ________ OF EACH YEAR
SPRING
FALL
SUMMER
WINTER
IF A MEDICARE PATIENT HAS SWITCHED OVER TO A MANAGED CARE PLAN AND WISHES TO DISENROLL, THE PATIENT MUST
CALL THE 800 NUMBER ON THEIR MEDICARE CARD
CALL THEIR MANAGED CARE PLAN
NOTIFY THEIR MANAGED CARE PLAN IN WRITING OF DISENROLLING
NOTIFY MEDICARE IN WRITING OF DISENROLLMENT
THE FEDERAL FALSE CLAIMS AMENDMENT ACT OFFERS FINANCIAL INCENTIVES OF ___ TO ____ OF ANY JUDGEMENT TO INFORMANTS WHO REPORT PHYSICIANS SUSPECTED OF DEFRAUDING THE FEDERAL GOVERNMENT
15% TO 25%
20% TO 25%
20%TO 50%
10% TO 15%
QUALITY IMPROVEMENT ORGANIZATION PROGRAM CONTRACTS WITH CMS TO REVIEW _____ REASONABLENESS, APPROPRIATENESS, AND COMPLETENESS AND ADEQUACY OF CARE GIVEN
PROCEDURES
MEDICAL NECESSITY
QUI TAM ACTION
BILLIN
IN A PARTICIPATING PHYSICIAN AGREEMENT, A PHYSICIAN AGREES TO ACCEPT PAYMENT FROM MEDICARE WHICH IS _____ OF THE MEDICARE APPROVED CHARGES
20%
80%
115%
85%
THE MEDICARE BENEFICIARY IS RESPONSIBLE FOR THE MONTHLY PREMIUM, ANNUAL DEDUCTIBLE AND ____ OF THE MEDICARE APPROVED CHARGES
IF YOU EXPECT MEDICARE TO DEY PAYMENT (ENTIRELY OR IN PART) INSTRUCT THE PATIENT TO SIGN A
CCN
CBS
CBN
ABN
MEDICARE PATIENTS WHO HAVE ADDITIONAL INSURANCE, MANY INSURANCE CARRIER GROUP PLANS AND MCO SENIOR PLANS REQUIRE
PRECERTIFICATION
PREDETERMINATION
AS OF OCTOBER 1, 2009, PROVIDERS NOW HAVE _______ MONTHS FROM THE DATE OF SERVICE TO FILE AND SUBMIT MEDICARE PLANS
12
15
24
6
ONE OF THE WAYS TO SUBMIT A CLAIM FOR A DECEASED PATIENT IS TO INSERT "_______" IN BLOCK 12 OF THE CMS 1500 CLAIM FORM WHERE THE PATIENT'S SIGNATURE IS NECESSARY
A PATIENT AUTHORIZES PAYMENT FOR SERVICES
PATIENT IS DECEASED
PATIENT DIED ON (INSERT DATE)
PATIENT EXPIRED
MEDICARE'S VERSION OF SENDING A CHECK IS A DOCUMENT CALLED
EXPLANATION OF EOB
EXPLANATION OF MEDICARE PAYMENTS
MEDICARE REMITTANCE ADVICE
EXPLANATION OF MEDICARE BENEFITS
THE DOCUMENT RECEIVED BY BENEFICIARY'S IN THE MAIL TO INDICATE HOW THEIR SERVICES WERE PAID IS CALLED
EXPLANATION OF BENEFITS
BENEFICIARY EXPLANATION
MEDICARE SUMMARY NOTICE
A __________ IS THE AMOUNT THAT MEDICARE PARTICIPATING PROVIDERS AGREE TO ACCEPT
ALLOWED AMOUNT
REASONABLE FEE
ALLOWABLE FEE
REIMBURSEMENT FEE
_________ ESTABLISHED FEDERAL STANDARDS, QUALITY CONTROL, AND SAFETY MEASURES FOR ALL FREESTANDING LABORATORIES, INCLUDING PHYSICIAN OFFICE LABORATORIES
CCI
COBRA
DCG
CLIA
THE PRIOR _______ NUMBER IS USED WHEN BILLING THE MEDICARE CARRIER AND IS ENTERED ON THE CMS-1500 CLAIM FORM
CERTIFICATION
DETERMINATION
CLAIM
AUTHORIZATION