Medicare's payment amount for services are determined by which of the following formulas?
a. Sustainable growth rate (SGR) X Geographic Practice Cost
... [Show More] Index (GPCI) = Medicare payment
b. Total RVU X Conversion factor = Medicare payment
c. Total Practice Expense (PE) X Conversion factor = Medicare payment
d. Total Malpractice insurance (MP) X Conversion factor (CF) = Medicare payment
b. Total RVU X Conversion factor = Medicare payment
The total RVU is composed of which of the following components:
a. Conversion factor (CF), practice expense (PE), and malpractice insurance (MP)
b. Physician work, practice expense (PE), and malpractice insurance (MP)
c. Sustainable growth rate (SGR), conversion factor (CF), and malpractice insurance (MP)
d. Sustainable growth rate (SGR), practice expense (PE), and physician work.
b. Physician work, practice expense (PE), and malpractice insurance (MP)
Medicare Supplement Insurance policies or Medigap is sold by:
a. Medicare
b. Medicaid
c. Private insurance companies
d. Healthcare providers
c. Private insurance companies
Medicare statutorily excluded services are:
a. Non-covered items and services
b. Not reimbursed by Medicare
c. Reimbursed on a case-by-case basis.
d. Both A & B
d. Both A & B
Albert has purchased a Medigap policy to supplement his Medicare benefits. To which entity will Albert pay his monthly premium for this policy?
a. Medicare
b. MAC
c. Medicaid
d. Medigap insurance company
d. Medigap insurance company
The term for a supplemental policy for Medicare is:
a. Medifill
b. Medicare Plus
c. Medigap
d. Medicare Secondary
c. Medigap
Dr. Allen who is a non-PAR provider performs an appendectomy on a 67 year-old Medicare patient. The physician's UCR for the surgery is $1500. Medicare's approved fee for this procedure is $1100. What is the limiting charge that this non-PAR provider can charge to this Medicare patient?
a. $1265
b. $1100
c. $1500
d. $1201.75
d. $1201.75
MAC is the acronym for:
a. Medicare Administrative Contractor
b. Medicare Advantage Contractor
c. Medical Access Center
d. Medicare Administrative Contact
a. Medicare Administrative Contractor
Andrew has selected TRICARE Prime as his health plan. Who will be responsible for coordinating his health care, maintaining his medical records and referrals to specialists when needed?
a. PCP - Primary Care Provider
b. PCC - Primary Care Coordinator
c. PCM - Primary Care Manager
d. PCN - Primary Care Networker
c. PCM - Primary Care Manager
To determine the Medicare coverage and payment policy for a service or procedure, which of the following resources will indicate if a service is payable, noncovered, or bundled into another service?
a. PC/TC indicator
b. Global surgery indicators
c. Status codes
d. Both A & B
c. Status codes
TRICARE and CHAMPVA timely filing is
a. 180-days from date of service
b. 1-year from the date of service
c. 90-days from the date of service
d. 120-days from the date of service
b. 1-year from the date of service
Barbara's late husband, Joe, was a lieutenant in the Navy. He served for 30 years, retiring 10 years prior to his death that was related to service connected disability. Barbara will still have healthcare coverage as Joe's widow under which of the following healthcare programs?
a. TRICARE
b. CHAMPVA
c. CHAMPUS
d. Medicare
b. CHAMPVA
Medicaid agencies are required to report EPSDT performance information
a. annually
b. monthly
c. quarterly
d. weekly
a. annually
Which of the three TRICARE options are not available to active duty service members?
a. TRICARE Prime
b. TRICARE Reserve Select
c. TRICARE Select
d. Both B & C
d. Both B & C
The Clinical Prior Authorization (PA) Program assists in the monitoring of:
a. drug interactions.
b. drugs not on Medicaid's formulary.
c. procedures that need prior authorizations.
d. Medicaid eligibility requirements.
b. drugs not on Medicaid's formulary.
Medicaid claims must be filed:
a. within 95 days.
b. within 365 days.
c. based on the individual state's timely filing requirement.
d. within 180 days.
c. based on the individual state's timely filing requirement.
When processing Medigap claims, Item 9a of the CMS 1500 claim form must have the policy and/or group number of the Medigap insured preceded by:
a. MEDIGAP
b. MG
c. MGAP
d. Any of the above.
d. Any of the above.
Which of the following services does Medicare consider preventive?
a. Depression screening
b. Bone mass measurements
c. Glaucoma screening
d. All of the above.
d. All of the above.
Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is a program associated with:
a. Medicare
b. Medicaid
c. Commercial insurance carriers
d. All insurance carriers
b. Medicaid
A Medicare patient receiving inpatient care in a critical access hospital would be covered under
a. Part C
b. Part B
c. Part A
d. Part D
c. Part A
Which of the following are mandatory benefits that must be provided by Medicaid programs in order to receive matching federal funding.
I. Outpatient hospital services
II. Podiatry services
III. Home health services
IV. Federally Qualified Health Center services
V. Inpatient hospital services
VI. Chiropractic services
VII. Occupational therapy
a. II, III, VII
b. I, III, IV, VI, VII
c. I, III, IV, V
d. IV, V, VI, VII
c. I, III, IV, V
Which TRICARE option allows enrollees the most choices utilizing the fee-for-service model?
a. TRICARE for Life
b. TRICARE Select
c. TRICARE Prime
d. Both A and B
b. TRICARE Select
Beth has purchased a Medigap policy to supplement her Medicare coverage. She has authorized Medicare to send payments directly to the physician, and Medicare has transferred their claims information to the Medigap insurance company. This transfer of information is known as:
a. Cross-under
b. Shared billing
c. Cross-over
d. Data sharing
c. Cross-over [Show Less]