Definitions
Medicare
Which of the following?
Medicaid
etc..
100
A primary care physician who controls patient access to specialists.
What is a gatekeeper?
100
Medicare outpatient coverage.
What is part B?
100
are covered by Medicare Part A? a. Physician outpatient services b. Physical therapy c. Outpatient surgery d. Hospice care
What is hospice care?
100
The two Medicaid eligibility classifications are the _____ needy and the _____ needy classes.
What is categorically and medically?
100
The (real) name of the legislation passed in 2010 that requires all Americans to have health insurance coverage?
What is patient protection and affordable care act?
200
Term used when a patient's services exceed a certain cost and the physician can begin asking the patient to pay for the services.
What is stop-loss?
200
Medicare is run by....
What is the Center for Medicare and Medicaid Services? (CMS)
200
is covered under Medicare Part B? a. Diagnostic tests b. Hospital rooms c. Hospice care d. Nursing care facilities
What is diagnostic tests?
200
Timely filing limits for the state of South Carolina Medicaid claim submission is _____ months.
What is 12?
300
Assigning an inaccurate CPT code to increase reimbursement.
What is upcoding?
300
When Medicare transmits a claims adjudication information electronically to another insurance plan
What is a crossover claim?
300
is when the Medicare Part A benefit period ends a. Is discharged from the hospital b. Has not been a bed patient in any hospital or nursing facility for 60 consecutive days c. Has not been a bed patient in any hospital or nursing facility for 30 consecutive days d. Has not been a bed patient in any hospital or nursing facility for 90 consecutive days
What is has not been a bed patient in any hospital or nursing facility for 60 consecutive days?
300
36. Medicare and Medicaid beneficiaries may not join an HMO. a. True b. False
What is false?
400
When a managed care plan requires the primary care physician to seek approval before a patient receives a service.
What is preauthorization?
400
The acronym for Medicare Secondary Payer program.
What is MSP?
400
is the name of the organization of physicians sponsored by a state or local medical association that is concerned with the development and delivery of medical services and the cost of health care? a. Foundation for Medical Care b. Physician provider group c. Health care cost containment organization d. Professional review organization
What is foundation for medical care?
400
38. The state Medicaid programs were a direct result of a. Funds provided by the Federal Emergency Relief Administration b. A law passed by the US Congress in 1950 c. The Social Security Act of 1935 d. Title XIX of the Social Security Act
What is a law passed by the US congress in 1950?
500
A secondary insurance policy purchased by the patient that covers the patient's Medicare deductible and coinsurance.
What is Medigap?
500
When a Medicare patient signs an Advance Beneficiary Notice (ABN), the procedure code for the service provided must be appended with THIS modifier.
What is -GA?
500
is the correct procedure to collect a copayment on a managed care plan? a. There is no copayment with a managed care plan b. Bill the plan for the copayment c. Bills the patient for the copayment d. Collect the copayment when the patient arrives for the office visit
What is collect the copayment when the patient arrives for the office visit?
500
Medicaid is administered by
What is state government with partial federal funding?
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