Term
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Definition
Medicare beneficiaries are responsible for paying for:
a) deductibles
b) premiums
c) coinsurance
d) all of the above |
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Term
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Definition
| The _________ is the 20% Medicare does not pay. |
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Term
| Congress; Federal Register; January 1 |
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Definition
| The maximum out-of-pocket amounts are set each year according to forumulas established by ________ and published in the __________. New amounts usually take effect each _________. |
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Term
| Quality Improvement Organization |
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Definition
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Term
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Definition
| an agreement a provider signs with a MAC to accept assignment on all claims submitted to Medicare |
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Term
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Definition
| What QIOs used to be known as |
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Term
| Participating Provider Organization |
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Definition
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Term
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Definition
| Under the direction of CMS, works with consumers, physicians, hospitals, and other caregivers to refine care delivery systems to make sure patients get right care at right time, particularly in under-served populations. |
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Term
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Definition
| T or F: A provider is allowed to bill the patient the difference for services for what Medicare does not pay |
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Term
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Definition
Incentives for physicians participating in QIOs:
a) Direct payment is made to provider on all claims
b) A 5% higher fee schedule than for non-QIO providers
c) faster processing of claims
d) Provider's name is in QIO directory made available to patients
e) Hospital referrals for outpatient care provide patient with one QIO provider
f) all of the above
g) b and d |
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Term
a
Payment goes to the patient on all claims |
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Definition
Which statement is NOT true of non-QIO providers:
a) Payment goes to the provider on all claims
b) A 5% lower fee schedule than for QIO providers
c) Slower processing of claims
d) A statement is sent out to Medicare patients reminding them they can lower expenses by using a QIO provider |
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Term
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Definition
| Hospitals report services for Part A using ________ codes and ________ assignment. |
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Term
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Definition
| T or F: Beneficiaries are automatically eligible for Part A when they are eligible for Medicare benefits |
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Term
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Definition
Part A pays for (in hospital inpatient stay):
a) semi-private room
b) meals
c) special diet
d) medically necessary services
e) personal convenience items
f) private duty nurses
g) all of the above
h) a-d
i) all but f |
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Term
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Definition
| Part A will pay for a skilled nursing facility and skilled rehabilitation if it is Medicare-certified and are based on _____. |
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Term
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Definition
Part A will pay for (in a skilled nursing facility):
a) semiprivate room
b) meals
c) nursing services
d) drugs
e) personal convenience items
f) private duty nurses
g) custodial nursing home services
h) all of the above
i) all but d-g |
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Term
| chronic long-term illnesses or disabilities |
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Definition
| In Part A, with skilled nursing facilities, personal convenience items, private duty nurses, and custodial nursing home services are provided to covered beneficiaries who have_________. |
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Term
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Definition
| T or F: Part A also covers home health visits and hospice |
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Term
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Definition
Part A will cover hospice if:
a) physician has certified patient is terminally ill
b) physican has certified that patient has less than 6 months to live
c) Patient has elected to receive care from hospice
d) hospice is Medicare-certified
e) all of the above
f) all but d
g) a and b |
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Term
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Definition
| T or F: Medicare Part B is automatically provided to beneficiaries when they are eligible for Medicare benefits. |
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Term
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Definition
Part B pays for:
a) physician services
b) outpatient hospital services
c) home health care
d) medical services and supplies not covered by Part A
e) all of the above
f) all but c |
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Term
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Definition
| Beneficiaries purchase Part B benefits with a _________ premium |
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Term
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Definition
| T or F: If Medicare recipients don't sign up for Medicare when they become eligible, they will be penalized by a cost that inflates 10% each year--and will stay in effect as long as they obtain coverage. |
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Term
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Definition
| What three types of codes are used to report Medicare Part B services? |
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Term
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Definition
| Known as Medicare Advantage |
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Term
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Definition
| Used to be known as Medicare + Choice |
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Term
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Definition
| a set of health care options from which Medicare beneficiaries can choose their health care providers and purchase additional benefits (hearing, vision, etc) that original Medicare does not offer |
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Term
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Definition
| a Medicare plan that offers drug coverage |
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Term
| Medicare Prescription Drug, Improvement, and Modernization Act of 2003 |
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Definition
| What act established Medicare Part D? |
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Term
| Health Insurance Portability and Accountability Act |
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Definition
| What does HIPAA stand for? |
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