Deck 9: Medicare

Question 1

In what year did Medicare stop paying for all consultation codes from the CPT evaluation and management, except for telehealth consultation G-codes?

A) 2012
B) 2005
C) 2010
D) 2000

Answer 1

2010

Question 2

Which of the following statements is true?

A) PAR providers cannot bill Medicare beneficiaries for missed appointments.
B) PAR providers cannot bill any patient, regardless of payer, for a missed appointment.
C) PAR providers can bill only Medicare beneficiaries for missed appointments.
D) PAR providers can bill both Medicare and non-Medicare patients for missed appointments.

Answer 2

PAR providers can bill both Medicare and non-Medicare patients for missed appointments.

Question 3

Medicare benefits are available to individuals in how many beneficiary categories?

A) five
B) four
C) three
D) six

Answer 3

six

Question 4

LCDs are

A) coverage decisions that help providers determine medical necessity.
B) coverage decisions that help providers determine medical necessity under Medicare.
C) sent to patients by the Medicare program to explain new services or procedures.
D) sent to providers by the Medicare program to explain new procedures.

Question 5

The modifier GZ is appended to procedure codes for noncovered Medicare services when

A) the item is excluded and an ABN is not required.
B) the item is expected to be denied as not reasonable but there is no signed ABN.
C) the item is expected to be paid in full.
D) the item is expected to be denied but there is a signed ABN.

Question 6

What does the abbreviation OIG stand for?

A) Office of the Internal General
B) Office of the Inspector General
C) Office of the Invasive General
D) Office of the Investigative General

Question 7

The Medicare limiting charge is the __________ fee that can be charged for a procedure by a nonparticipating provider.

A) highest
B) flexible
C) rotating
D) lowest

Question 8

The Medicare program

A) employs MACs to pay the Medicare beneficiary.
B) directly pays the Medicare beneficiary.
C) directly pays the claims submitted by providers.
D) employs MACs to pay the claims submitted by providers.

Question 9

___________ adults may be eligible for Medicare benefits.

A) Disabled
B) Lower-income
C) Homeless
D) Incarcerated

Question 10

E/M services during a global period that are unrelated to the procedure can be billed with what modifier?

A) -25
B) -59
C) -24
D) -51

Question 11

Under the Affordable Care Act, when must Medicare Part B providers file their claims?

A) no later than the end of the calendar year following the year in which the service was furnished
B) within one calendar year after the date of service
C) within six months after the date of service
D) no later than the end of the calendar year in the same year in which the service was furnished

Question 12

Services supervised by the physician but provided by nonphysician practitioners are billed under

A) Medicare Part A.
B) clinical lab rules.
C) incident-to rules.
D) Medicare Part C.

Question 13

The modifier GY is appended to procedure codes for noncovered Medicare services when

A) the item is expected to be denied as not reasonable but there is not a signed ABN.
B) the item is expected to be denied but there is a signed ABN.
C) the item is expected to be paid in full.
D) the item is excluded and an ABN is not required.

Question 14

Under the Medicare program, if the approved amount for a procedure is $100, the participating physician will be paid $100 (by Medicare and the patient), and the nonparticipant who accepts assignment will be paid

A) $95.
B) $115.
C) $80.
D) $100.

Question 15

What is the abbreviation for annual wellness visit?

A) AV
B) WV
C) AW
D) AWV

Question 16

CLIA is a federal law that established standards for

A) ancillary supplies.
B) durable medical equipment.
C) pathology reporting.
D) laboratory testing.

Question 17

Which of the following is excluded under Medicare?

A) routine medical appliances
B) medical nutritional therapy for beneficiaries with diabetes
C) counseling for obesity
D) cardiovascular disease screening blood tests

Question 18

A screening service is defined as one that is

A) done to discover if a patient has a diagnosed disease that is progressing.
B) done when the patient has a long history of the disease that is being screened.
C) to check for family history.
D) done to discover if a patient has an undiagnosed disease.

Question 19

Anyone over age 65 who receives Social Security benefits is automatically

A) enrolled in Medicare Part A and eligible for Medicare Part B.
B) neither enrolled in Medicare Part A nor eligible for Medicare Part B.
C) eligible for Medicare Part B.
D) enrolled in Medicare Part A.

Question 20

The limiting charge under the Medicare program can be billed by

A) either participating or nonparticipating providers.
B) participating providers only.
C) neither participating or nonparticipating providers.
D) nonparticipating providers only.

Question 21

Medicare Physician Fee Schedule amounts are __________ higher than for nonparticipating providers.

A) 10%
B) 15%
C) 30%
D) 5%

Question 22

Outpatient hospital benefits are provided under

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

Question 23

Which of the following statements is correct?

A) Physicians must accept Medicare patients, per federal statute.
B) Physicians who participate in Medicare may decide whether to accept assignment on a claim-by-claim basis.
C) Physicians who do not participate in Medicare may decide whether to accept assignment on a claim-by-claim basis.
D) Physicians will receive the same amount of reimbursement regardless if they participate in the Medicare program or not.

Question 24

MAO is the abbreviation for

A) Medicare Accounts Organization.
B) Medical Advantage Organization.
C) Medicare Advantage Organization.
D) Medical Accounts Organization.

Question 25

MMA is the abbreviation for

A) Medical Modernization Act.
B) Medicare & Medicaid Modernization Act.
C) Medicare Modernization Act.
D) Medicaid Modernization Act.

Question 26

CWF is the abbreviation for

A) Common Working Force.
B) Case Working File.
C) Common Working File.
D) Case Working Force.

Question 27

ABN is the abbreviation for

A) Advance Beneficiary Notice.
B) Annual Beneficiary Notice.
C) Applicable Beneficiary Notice.
D) Absolute Beneficiary Notice.

Question 28

CMS accepts only signatures that are

A) handwritten.
B) electronic.
C) facsimiles of original written/electronic signatures.
D) all of these are correct.

Question 29

What is the legislation that redesigned the Medicare Part B reimbursement incentive and mandated the transition to the Medicare Beneficiary Identifier?

A) MBI
B) HPSA
C) MMA
D) MACRA

Question 30

Providers located in areas designated by Medicare as HPSAs are eligible for __________ bonus payments from Medicare.

A) 15%
B) 10%
C) 2.5%
D) 5%

Question 31

Which part of Medicare covers influenza, pneumococcal polysaccharide vaccine, and hepatitis B virus vaccinations?

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

Question 32

CLIA is the abbreviation for

A) Clinical Laboratory Improvement Amendments.
B) Coding Laboratory Improvement Act.
C) Coding Laboratory Improvement Amendments.
D) Clinical Laboratory Improvement Act.

Question 33

Which of the following is excluded from Medicare coverage?

A) glaucoma screening
B) routine dental examinations
C) HIV testing
D) tobacco cessation counselling

Question 34

Medicare requires the use of which coding set for procedures and services?

A) CPT
B) ICD-10
C) HCPCS
D) CPT/HCPCS

Question 35

Medicare Administrative Contractors (MACs) process Medicare claims for which of the following?

A) None of these is correct
B) Medicare beneficiaries
C) Medigap holders
D) BCBS policy holders

Question 36

All laboratory work paid for by Medicare is regulated by

A) CLIA rules.
B) HPSA rules.
C) NPI rules.
D) NEMB rules.

Question 37

Physicians who participate in the Medicare program must

A) accept assignment.
B) file claims for beneficiaries.
C) participating physicians do not have to do any of these.
D) accept assignment and file claims for beneficiaries.

Question 38

The deductible for Medicare Part B is

A) set each year.
B) there is not a deductible.
C) based on the national debt.
D) tied to the benefit period.

Question 39

Patients with end-stage renal disease (ESRD) are entitled to Medicare benefits until

A) they reach the age of 30.
B) They can be any age as long as they receive dialysis or a renal transplant.
C) after reaching the age of 65.
D) they reach the age of 65.

Question 40

The modifier GA is appended to procedure codes for noncovered Medicare services when

A) the item is expected to be denied as not reasonable but there is not a signed ABN.
B) the item is expected to be paid in full.
C) the item is excluded and an ABN is not required.
D) the item is expected to be denied but there is a signed ABN.

Question 41

All of the following are noncovered items under Medicare except

A) ultrasound screening for abdominal aortic aneurysms.
B) custodial services.
C) long-term care.
D) acupuncture.

Question 42

Which of the following statements is true?

A) Retired federal employees who are enrolled in the Civil Service Retirement System are eligible for Medicare benefits, as are their spouses over age 65.
B) Retired federal employees and their spouses who are enrolled in the Civil Service Retirement System are not eligible for Medicare benefits.
C) Retired federal employees who are enrolled in the Civil Service Retirement System are not eligible for Medicare benefits.
D) Retired federal employees who are enrolled in the Civil Service Retirement System are eligible for Medicare benefits, but their spouses are not.

Question 43

How many Medigap plans are available?

A) 4
B) 8
C) 6
D) 10

Question 44

What is performed for a patient who does not have symptoms, abnormal findings, or any past history of the disease?

A) surgical procedure
B) referral service
C) rehabilitation
D) screening service

Question 45

People who are over age 65 but who are not eligible for free Part A coverage may enroll by

A) paying a premium.
B) enrolling in a Medicare HMO.
C) paying a deductible.
D) paying into a Medical Savings Account.

Question 46

Medicare beneficiaries can select from how many main types of coverage plans?

A) one
B) four
C) there is no choice
D) two

Question 47

Hospital benefits are provided under

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

Question 48

A program that provides incentives for physicians for reporting on quality of care performance measures is called

A) Advance Beneficiary Notice.
B) Notice of Exclusions from Medicare Benefits.
C) False Claim Act Notice.
D) Quality Payment Program.

Question 49

If a Medicare PAR physician thinks that a planned procedure will not be found medically necessary by Medicare and so will not be reimbursed, the patient should be asked to sign a(n)

A) Medicare waiver.
B) advance beneficiary notice.
C) notice of exclusions from Medicare benefits.
D) Medicare Summary Notice.

Question 50

Medicare may classify conditions that are not covered as

A) not medically necessary.
B) un-reimbursable.
C) fraudulent.
D) none of these is correct.

Question 51

HPSA is the abbreviation for

A) Health Persons Shortage Area.
B) Health Professional Staffing Agency.
C) Health Professional Shortage Area.
D) Health Persons Staffing Agency.

Question 52

Supplemental insurance plans for Medicare beneficiaries provide additional coverage for an individual receiving benefits under which Medicare Part?

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

Question 53

Urgently needed care is defined in the Medicare program as

A) a chronic illness that has suddenly become an acute condition.
B) a life-threatening injury that needs emergency room care.
C) an unexpected illness or injury that requires immediate treatment.
D) a life or death situation.

Question 54

Under the Medicare program, a nonparticipating physician may not bill more than 115 percent of

A) the Medicare approved amount from the MFS.
B) the approved charge on the nonPAR fee schedule.
C) neither the Medicare approved amount from the MFS nor the approved charge on the nonPAR fee schedule.
D) either the Medicare approved amount from the MFS or the approved charge on the nonPAR fee schedule, whichever is lower.

Question 55

Which of the following is excluded under Medicare?

A) cosmetic surgery
B) bone mass measurements
C) screening for alcohol misuse
D) influenza vaccination

Question 56

Under the Medicare global surgical package

A) only the post-operative visit can be billed in addition to the surgery itself.
B) only the pre-operative visit can be billed in addition to the surgery itself.
C) all pre- and postoperative visits can be billed in addition to the surgery itself.
D) related pre- and postoperative visits cannot be billed in addition to the surgery.

Question 57

What is the abbreviation CCI for?

A) Clinical Coding Initiative
B) Correct Coding Initiative
C) Clinical Coding Indicator
D) Correct Coding Indicator

Question 58

An easy to perform low-risk lab test that can be performed by CLIA in the physician's office is called a(n)

A) roster test.
B) rapid strep test.
C) waived test.
D) incident-to test.

Question 59

Patients receive a __________ that details the services they were provided over a thirty-day period, the amounts charged, and the amounts they may be billed.

A) Medicare Summary Notice
B) Medicare Statement
C) Medicare Notice
D) Medicare Statement Notice

Question 60

A Medigap plan is

A) a part of Medicare to help supplement costs.
B) an insurance offered by private insurance.
C) an insurance offered by state governments.
D) a part of Medicare that will pay for Medicare's monthly premiums.

Question 61

Each Medicare enrollee receives a __________ issued by CMS.

A) Medicare Beneficiary Card (MBC)
B) Medicare card
C) Medicard
D) Medicare Benefit Card (MBC)

Question 62

What is the collection of online articles that explain all Medicare topics?

A) Medicare Learning Network (MLN) Matters
B) Medicare National Coverage Determinations
C) Medicare Program Integrity
D) Medicare Contractor Beneficiary and Provider Communications

Question 63

Who has the right to appeal denied Medicare claims?

A) Providers have the right to appeal denied Medicare claims.
B) Patients have the right to appeal denied Medicare claims.
C) Neither; a Medicare denied claim cannot be appealed.
D) Both patients and providers have the right to appeal denied Medicare claims.

Question 64

How many CMS regional offices are there?

A) fourteen
B) twelve
C) ten
D) eight

Question 65

Roster billing applies to which Part of Medicare?

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

Question 66

What does the abbreviation MSA stand for in the Medicare program?

A) Medicare Supplemental Account
B) Medicare Savings Account
C) Medical Savings Account
D) Medical Supplemental Account

Question 67

The Medical Review program focuses on

A) credentials of biller.
B) timeliness of billing.
C) late billing.
D) inappropriate billing.

Question 68

Medicare Part B beneficiaries pay a monthly premium that is calculated based on which of the following?

A) Social Security benefit rates
B) income
C) part B does not have a monthly premium
D) age

Question 69

__________ are paid to process claims for government medical insurance programs.

A) HHS
B) RACs
C) MACs
D) HPSA

Question 70

A duplicate claim is defined as

A) those sent to one or more Medicare contractors from the same provider for the same beneficiary, the same service for different dates of service.
B) those sent to one or more Medicare contractors from the same provider for different beneficiaries, the same service, and the same date of service.
C) those sent to one or more Medicare contractors from the same provider for the same beneficiary, different dates of service, and the same date of service.
D) those sent to one or more Medicare contractors from the same provider for the same beneficiary, the same service, and the same date of service.

Question 71

Roster billing is used to file simplified claims for certain

A) Medicare screening programs.
B) Medicare beneficiaries who have Medigap.
C) Medicare providers.
D) Medicare immunization programs.

Question 72

Telehealth consultations should be assigned a code from which section for Medicare beneficiaries?

A) CPT Evaluation and Management
B) determined by the circumstance around that telehealth consultation
C) HCPCS G-codes
D) ICD-10-PCS

Question 73

What does CCP stand for?

A) Medicare coordinated care plans
B) coordinating care with providers
C) coordinated care provider
D) Medicare coordinating care with providers

Question 74

What percentage of the fee on the Medicare nonPAR Fee Schedule is the limiting charge?

A) 80 percent
B) 85 percent
C) 100 percent
D) 115 percent

Question 75

The Medicare fee-for-service plan, referred to by Medicare as the __________, allows the beneficiary to choose any licensed physician certified by Medicare.

A) Original Medicare Plan
B) Former Medicare Plan
C) Basic Medicare Plan
D) Old Medicare Plan

Question 76

Paper claims cannot be paid before what day after receipt of the claim?

A) the 10th day
B) the 60th day
C) the 45th day
D) the 29th day

Question 77

Which of the following is considered the best defense under the Medicare Integrity Program?

A) using a billing service
B) having a strong compliance plan
C) using special coding software
D) having credentialed coders

Question 78

Which of the following is also called Supplemental Medical Insurance?

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

Question 79

Which of the following plans is offered by Medicare Advantage?

A) Medicare Savings Accounts (MSAs)
B) Medicare coordinated care plans (CCPs)
C) All of these answers are correct
D) Medicare private fee-for-service plans

Question 80

Incident-to-services and supplies are performed or provided by

A) medical assistants.
B) phlebotomists.
C) physician assistants and nurse-practitioners.
D) radiology technicians.