MEDICARE
MILITARY INSURANCE
MAINECARE
COMMERCIAL INSURANCE
MISC
100
In Medicare terminology, a beneficiary is a person who:
a.Qualifies for Medicare coverage because they are 65 years old or older. b.Qualifies for Medicare because of a disability. c.Qualifies for Medicare because of ESRD.
100
If a patient has Medicare and Martins point, you may only bill ?
Martin's Point unless the patient has ESRD, than Medicare would be the primary insurance to bill and Martin's point would be billed as a secondary insurance.
100
Is it Mainecare or Mainecare managed that has a review group?
Mainecare does not have a review group. Mainecare Managed does have a review group.
100
BC of ME starts with what letter? What is XVB for?
-X -Medicare Supplement
100
How do you prioritize Indian Health Insurance? What is the ID number for these insurances?
Always selected last,unless the only insurance. Patients social security number.
200
If a patient has Medicare Part A and Part B, identify the Medicare Health Plan that will cover an Inpatient Hospital Stay.
Medicare Part A
200
For Tricare and Tricare for Life, who is the subscriber and where is the benefit number located on the card?
The military person is always the subscriber. The benefit number is on the back of the card.
200
You do not need a Mainecare auth if the patient has either _____ or _____ for a PCP
PCHC or SVH
200
Cigna usually starts with what letter? What does Harvard Pilgrim usually starts with?
U HP
200
What do you put in the address field when the patient is homeless?
Homeless and gather any information the patient is able to provide.
300
If a patient has Medicare Part A and Part B. What is the Medicare Health Plan that covers physician services and diagnostic tests.
Medicare Part B
300
For Tricare for Life what happens if the holder of the insurance becomes deceased?
The sponsor of the insurance plan changes to the living spouses’ name with the military benefit number as the patient contract
300
If you can't get a referral through the MIHMS website, you have to call the patients _______ office. If you have to leave a message, what information do you need to state?
Primary Care Physician 1) Patient name & DOB 2) Appointment date 3) Where the appointment is (clinic) 4) Chief complaint 5) Ordering physician 6) Preregistration phone number
300
What are the coordination of benefits for a child who is covered by two commercial insurances? (Birthday Rule)
Dependent children, the plan of the parent whose birthday falls earlier in the year is primary (Birthday Rule). Only the month and day are considered when determining whose birthday falls earlier.
300
What two questions do you need to ask when you are talking to a Nursing facility?
1) Is the patient long term or short term? 2) Can the patient sign for themselves?
400
Is Medicare primary or secondary when the patient is disabled, under the age of 65, and has a Large Group Health Plan?
Secondary
400
What are 3 facts about Champ VA?
1) Patient is always the subscriber 2) Policy number is always the patients ss# - NOT the military person. 3) This military insurance is for the family only.
400
What do you do if you see "Mainecare Pending/MRT"?
You DO NOT remove it. You can check EEM to see if it's active and if it is you can update accordingly.
400
What do you have to remove to verify Maine Community Health Options ? Where do you have to go to verify this insurance?
The last 3 digits of the patients ID number usually 001, 002,003 Maine Community Health Options website
400
Minors under the age of 18 who are scheduled for an appointment at EMMC can sign their own consent if it’s under what circumstances?
Family Planning Pregnancy STDs Psychiatric Substance Abuse
500
Is medicare primary or secondary if the patient is over the age of 65 and is working at a company that has over 20 employees?
Secondary
500
When a patient has Veterans Administration insurance what question do you need to ask and what do you need to type in the front and back comments?
" Is the Veterans Administration paying for this visit?" Front/Back comments note "Bill to VA per Patients Request"
500
What are exemptions within the MaineCare referral? (11)
Family Planning STD’s Breast Exams Pregnancy Substance Abuse ER Psychiatric Diagnoses Xrays Labs CTs Petscans
500
What can an Aetna Medicare Advantage Plan begin with?
Aetna Medicare prefixes are usually with MEB or ME
500
Explain Mainecare QMB?
The patient has coverage because they are a “Qualified Medicare Beneficiary"
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