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MEDICARE

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letty reyes
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MEDICARE BY LETTY

Question 1 of 32

1

CMS IS SHORT FOR

Select one of the following:

  • CENTERS FOR MEDICARE AND MEDICAID SERVICES

  • CENTERS FOR MEDICAID AND MEDICARE SERVICES

  • SERVICES FOR MEDI-MEDI SERVICES

  • CENTERS FOR MEDICARE SERVICES

Explanation

Question 2 of 32

1

MEDICAID IS ADMINISTERED BY

Select one of the following:

  • CMS

  • TMHP

  • MCS

  • CNS

Explanation

Question 3 of 32

1

MEDICARE PART A IS FOR

Select one of the following:

  • PROVIDER SERVICES

  • OUTPATIENT SERVICES

  • HOSPITAL SERVICDES

  • DME SERVICES

Explanation

Question 4 of 32

1

MEDICARE IS A ____________ PROGRAM

Select one of the following:

  • STATE

  • LOCAL

  • FEDERAL

  • STATE/FEDERAL

Explanation

Question 5 of 32

1

OVER THE PERIOD OF _________ YEARS, DEPARTMENT OF HEALTH AND HUMAN SERVICES WILL DISTRIBUTE REPLACEMENT CARDS TO MEDICARE BENEFICIARIES

Select one of the following:

  • 6-4

  • 7-8

  • 4-8

  • 3-4

Explanation

Question 6 of 32

1

IF A CARD SHOWS HMO, THEN THE PATIENT SIGNED UP AND IS COVERED BY A ____

Select one of the following:

  • PRIVATE INSURANCE

  • PREFERRED PROVIDER ORGANIZATION

  • MANAGED CARE PLAN

  • TRADITIONAL FEE FOR SERVICE

Explanation

Question 7 of 32

1

THE LETTER C IDENTIFIES THAT THE INSURED IS THE

Select one of the following:

  • WIDOW

  • SPOUSE

  • BENEFICIARY

  • DISABLED CHILD

Explanation

Question 8 of 32

1

A RAILROAD MEDICARE BENEFICIARY IDENTIFICATION NUMBER BEGINS WITH A

Select one of the following:

  • NUMBER OR NUMBERS

  • LETTER OR LETTERS

  • POUND SIGN

  • SPECIAL CHARACTER

Explanation

Question 9 of 32

1

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

Select one of the following:

  • A

  • B

  • C

  • D

Explanation

Question 10 of 32

1

ESRD IS SHORT FOR

Select one of the following:

  • EVEN STAGE RENAL DISORDERS

  • END STATE RENAL DISEASE

  • END SPECIAL RENAL DISEASE

  • END STATES RENAL DISEASES

Explanation

Question 11 of 32

1

MEDICARE PART B HAS AN ANNUAL ______ THAT CONTINUES TO INCREASE BY THE SOCIAL SECURITY ADMINISTRATION

Select one of the following:

  • COPAYMENT

  • PREAUTHORIZATION

  • CO-INSURANCE

  • PREMIUM

Explanation

Question 12 of 32

1

MEDICARE PART ___ IS COMMONLY REFERRED AS MEDICARE ADVANTAGE PLAN

Select one of the following:

  • A

  • B

  • C

  • D

Explanation

Question 13 of 32

1

MEDICARE PART D IS FOR PRESCRIPTION COVERAGE AND MOST OF THE MEDICARE DRUG PLANS HAVE COVERAGE GAP KNOWN AS

Select one of the following:

  • GAP

  • LAPSE IN COVERAGE

  • DONUT HOLE

  • FORMELY

Explanation

Question 14 of 32

1

MEDICAL INSURANCE FOR RAILROAD RETIREMENT BENEFITS PREMIUMS ARE AUTOMATICALLY DEDUCTED FROM

Select one of the following:

  • EMPLOYER PAYCHECKS

  • MONTHLY CHECKS RECEIVED OF PEOPLE WHO RECEIVE RAILROAD RETIREMENT

  • FROM THE BENEFICIARY'S CHECKING ACCOUNT

  • THE BENEFICIARY'S SAVINGS ACCOUNT

Explanation

Question 15 of 32

1

MEDICARE SECONDARY PAYER (MSP) DEFINES MEDICARE TO BE

Select one of the following:

  • PRIMARY PAYER

  • SECONDARY PAYER

  • PAYER OF LAST RESORT

  • TERTIARY PAYER

Explanation

Question 16 of 32

1

A ________ IS A LIST OF THE DRUGS THAT A PLAN COVERS

Select one of the following:

  • FORMULARY

  • LIST OF APPROVED DRUGS

  • MEDICARE PRESCRIPTIONS DRUG COVERAGE

  • TIER ONE LIST

Explanation

Question 17 of 32

1

MEDICARE MAKES PAYMENTS DIRECTLY TO THE _______ ON A MONTHLY BASIS FOR MEDICARE ENROLLEES WHO USE THE HMO OPTION

Select one of the following:

  • PATIENT

  • PROVIDER

  • HMO

  • PPO

Explanation

Question 18 of 32

1

MEDICARE ADVANTAGE PLANS (HMO'S OR PPO'S) HAVE AN OPEN ENROLLMENT PERIOD IN THE ________ OF EACH YEAR

Select one of the following:

  • SPRING

  • FALL

  • SUMMER

  • WINTER

Explanation

Question 19 of 32

1

IF A MEDICARE PATIENT HAS SWITCHED OVER TO A MANAGED CARE PLAN AND WISHES TO DISENROLL, THE PATIENT MUST

Select one of the following:

  • 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

Explanation

Question 20 of 32

1

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

Select one of the following:

  • 15% TO 25%

  • 20% TO 25%

  • 20%TO 50%

  • 10% TO 15%

Explanation

Question 21 of 32

1

QUALITY IMPROVEMENT ORGANIZATION PROGRAM CONTRACTS WITH CMS TO REVIEW _____ REASONABLENESS, APPROPRIATENESS, AND COMPLETENESS AND ADEQUACY OF CARE GIVEN

Select one of the following:

  • PROCEDURES

  • MEDICAL NECESSITY

  • QUI TAM ACTION

  • BILLIN

Explanation

Question 22 of 32

1

IN A PARTICIPATING PHYSICIAN AGREEMENT, A PHYSICIAN AGREES TO ACCEPT PAYMENT FROM MEDICARE WHICH IS _____ OF THE MEDICARE APPROVED CHARGES

Select one of the following:

  • 20%

  • 80%

  • 115%

  • 85%

Explanation

Question 23 of 32

1

THE MEDICARE BENEFICIARY IS RESPONSIBLE FOR THE MONTHLY PREMIUM, ANNUAL DEDUCTIBLE AND ____ OF THE MEDICARE APPROVED CHARGES

Select one of the following:

  • 20%

  • 80%

  • 115%

  • 85%

Explanation

Question 24 of 32

1

IF YOU EXPECT MEDICARE TO DEY PAYMENT (ENTIRELY OR IN PART) INSTRUCT THE PATIENT TO SIGN A

Select one of the following:

  • CCN

  • CBS

  • CBN

  • ABN

Explanation

Question 25 of 32

1

MEDICARE PATIENTS WHO HAVE ADDITIONAL INSURANCE, MANY INSURANCE CARRIER GROUP PLANS AND MCO SENIOR PLANS REQUIRE

Select one of the following:

  • PRECERTIFICATION

  • PREAUTHORIZATION

  • PREDETERMINATION

  • COPAYMENT

Explanation

Question 26 of 32

1

AS OF OCTOBER 1, 2009, PROVIDERS NOW HAVE _______ MONTHS FROM THE DATE OF SERVICE TO FILE AND SUBMIT MEDICARE PLANS

Select one of the following:

  • 12

  • 15

  • 24

  • 6

Explanation

Question 27 of 32

1

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

Select one of the following:

  • A PATIENT AUTHORIZES PAYMENT FOR SERVICES

  • PATIENT IS DECEASED

  • PATIENT DIED ON (INSERT DATE)

  • PATIENT EXPIRED

Explanation

Question 28 of 32

1

MEDICARE'S VERSION OF SENDING A CHECK IS A DOCUMENT CALLED

Select one of the following:

  • EXPLANATION OF EOB

  • EXPLANATION OF MEDICARE PAYMENTS

  • MEDICARE REMITTANCE ADVICE

  • EXPLANATION OF MEDICARE BENEFITS

Explanation

Question 29 of 32

1

THE DOCUMENT RECEIVED BY BENEFICIARY'S IN THE MAIL TO INDICATE HOW THEIR SERVICES WERE PAID IS CALLED

Select one of the following:

  • EXPLANATION OF BENEFITS

  • BENEFICIARY EXPLANATION

  • MEDICARE SUMMARY NOTICE

  • MEDICARE REMITTANCE ADVICE

Explanation

Question 30 of 32

1

A __________ IS THE AMOUNT THAT MEDICARE PARTICIPATING PROVIDERS AGREE TO ACCEPT

Select one of the following:

  • ALLOWED AMOUNT

  • REASONABLE FEE

  • ALLOWABLE FEE

  • REIMBURSEMENT FEE

Explanation

Question 31 of 32

1

_________ ESTABLISHED FEDERAL STANDARDS, QUALITY CONTROL, AND SAFETY MEASURES FOR ALL FREESTANDING LABORATORIES, INCLUDING PHYSICIAN OFFICE LABORATORIES

Select one of the following:

  • CCI

  • COBRA

  • DCG

  • CLIA

Explanation

Question 32 of 32

1

THE PRIOR _______ NUMBER IS USED WHEN BILLING THE MEDICARE CARRIER AND IS ENTERED ON THE CMS-1500 CLAIM FORM

Select one of the following:

  • CERTIFICATION

  • DETERMINATION

  • CLAIM

  • AUTHORIZATION

Explanation