MCR Parts
Medicare
Acronym
Medicaid
MISC
100

Part _____ of Medicare includes Medicare Advantage options

WHAT IS PART C

100

A federal insurance program, established in 1966, for people 65 years old and older and certain other qualifying individuals is

what is Medicare

100

The acronym for the Medicaid program that was formerly referred to as AFDC is

WHAT IS TANF

100

A combination federal/state medical assistance program that provides comprehensive and quality medical care for certain categories of low-income and qualifying elderly people is

What is Medicaid

100

When an individual is covered under both Medicaid and Medicare and/or a private healthcare policy, the payer of last resort is always

what is Medicaid

200

Part _____ of Medicare helps pay for charges incurred during an inpatient hospital stay.

WHAT IS A
200

Individuals pay for Medicare Part B coverage through

what is monthly premiums

200

When it is likely that Medicare will not pay for a service or procedure that Medicare ordinarily covers but is likely to be denied on this particular occasion, the patient should be asked to sign a/an

WHAT IS ABN

200

To qualify for supplemental security income (SSI), individuals must meet certain financial guidelines set by

what is Federal Poverty Level

200

The Medicaid program is administered by

WHAT IS CMS

300

Part _____ of Medicare helps pay for physician and outpatient charges

WHAT IS B

300

The duration of time during which a Medicare beneficiary is eligible for Part A benefits for inpatient hospital or skilled nursing facility charges is called a/an

what is benefit period

300

Medicare’s fee schedule is based on a system whereby each payment value is found within a range of payments known as

What is RBRVS

300

Medically needy individuals can reduce their assets to the Medicaid eligibility level by deducting medical expenses; this is called a/an

what is spend down

300

An individual who is eligible for both Medicare and Medicaid programs is said to be a/an

what is dual eligible

400

Part _____ of Medicare helps pay for prescription drugs.

WHAT IS D

400

When a service or procedure meets Medicare’s criteria for coverage, it is said to be

what is medically necessary 

400

The act that established quality standards for all laboratory testing to ensure safety, accuracy, reliability, and timeliness is

what is CLIA

400

Individuals who receive medical assistance because their income falls within the poverty or FPL guidelines or as a result of SSI eligibility are considered

what is categorically needy

400

There are _____ levels to the Medicare appeals process

what is 5

500

There are _____ parts to the Medicare program.

WHAT IS 4

500

The term used when Medicare is not responsible for paying first because of coverage under another insurance policy is

what is Medicare Secondary Payer

500

The job of a ______________________ is to detect and correct past improper payments so that CMS and MACs can implement actions that will prevent future improper payments.

WHAT IS RAC (recovery audit contractor)

500

Before providing services to patients claiming to be on Medicaid, the health insurance professional should

what is verify eligibility

500

An individual is generally not eligible to select a Medicare Advantage plan if he or she has been diagnosed with _________.

what is ESRD

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