Leaderboard

Test Your Medicare/Medicaid Knowledge

Multiple Choice

1.

Patient is requesting a screening test to be performed.Medicare does not pay for, if there is no supporting diagnosis or medical necessity in the medical record, therefore the patient is responsible for the screening laboratory test.  She is asked to sign the ABN and was informed Medicare will not pay for the test.  She wants to proceed with the test and believes she can appeal Medicare's decision.  Which option (1 , 2 or 3) is check by the patient for this scenario?

a. Option 1

b. Option 2

c. Option 3

d. No ABN is required

2.

What is the name of the Medicare program that offers products such as HMO, PPO, MSA and other Medicare insurance policies?

a. Medicare Part D

b. Medicare Part C

c. Medigap Insurance

d. QMB for patients that have Medicare and Medicaid

3. Which answer below is not a Medicare eligibility requirement?

a. Be a citizen or permanent resident of the United States

b. Must have worked at least 10 years in a Medicare covered employment position

c. Be a minimum age of 65 or disability

d. Must have income of less than $50,000 to qualify for Medicare Part B

4.

Which answer correctly identifies how MBI numbers are identified on the Medicare beneficaries cards?

a. 2nd, 5th, 8th and 9th characters will always be a letter

b. Character 1, 4, 7, 10 and 11 will always be a number

c. 3rd and 6th characters will be a letter or number

d. All of the answers above

5.

What are Medigap policies?

a. State Medicaid plans to fill in the “gaps” of healthcare costs that Medicare does not pay

b. Health insurance sold by private insurance to help pay for some costs the Medicare plan doesn’t cover

c. It is considered a Medigap policy when the beneficiary has Medicare Part A, B and Medicaid

d. Medicare HMO plans

6. What is EPSDT?

a. Medicaids comprehensive preventative child health care program for individuals 0-21 years of age

b. Medicaid HMO

c. Medicaid program for children with disabilities that are considered permanent disabilities such as blindness, deafness, CP, etc.

d. Medicare program for beneficiaries with End Stage Renal Disease

7. Who funds and administers Medicaid benefits?

a. Funded and administered by private payers per state

b. Funded and administered state legislature

c. Federally funded program, and administered by each state

d. Funded and administered by local governments and counties

8.

Medicare patient is admitted to the hospital for pneumonia.  They have not met any of the deductible for the year.  Which Medicare program covers the hospital stay and how much will the patient be responsible to pay?

a. Medicare Part B pays for hospital benefits and the patient will be responsible for 20% of the Medicare allowable and their deductible.

b. Medicare part A pays for hospital benefits and the patient will be responsible for the Part B deductible

c. Medicare Part A pays for hospital benefits and the patient will be responsible for 20% of the Medicare allowable and Part A deductible.

d. Medicare Part D pays for hospital benefits and the patient will be responsible for 20% of the Medicare allowable and their Part A deductible.

9.

Patient is admitted to the hospital with a hip fracture.  The patient fell on ice at a friends home.  The patient has Medicare and Medicaid.  How will the claim be billed to insurance carriers?

a. Medicare insurance is billed first and personal property insurance is billed second. Medicaid is billed last.

b. Personal property insurance is billed first and Medicare is billed second and Medicaid billed last

c. Since Medicare and Medicaid are federally funded programs, only Medicare and Medicaid can be billed

d. Due to third party liability of the accident, only personal property insurance can be billed and the patient cannot be held responsible for any deductibles or coinsurance. Medicare cannot be billed but Medicaid can be billed

10.

Which answer is TRUE for the definition of a Participating Provider with Medicare?

a. Participating providers agree to accept assignment of claims, and payment is sent directly to the provider. Non-participating providers do not accept assignment and payment is sent to the patient.

b. Participating providers agree to accept assignment of claims, payment is sent directly to the provider. Non-participating providers do not accept assignment, have limiting fees, payment is sent to the provider.

c. Participating providers agree to accept assignment of claims on a claim by claim basis and payment is sent to either the patient or the provider. Non-participating providers do not accept assignment and payment is sent to the patient.

d. None of the answers above, Participating or Non-Participating providers is terminology only used for Medicaid.

11.

What is the definition of QMB?

a. Qualified individuals that have lost their Medicare coverage because of work but have a low FPL.

b. Individuals that have been denied Medicaid coverage due to income but qualify as "medically needy" due to health status

c. Medicare pays premiums, deductibles and coinsurance for those at or below 100% of FPL or twice the standard allowed under SSI

d. Individuals who qualify for Medicare Part A, B but have Chronic Kidney Disease through an employer and still working

12.

Which answer is FALSE for Medicare Part D?

a. Medicare Part D are private companies approved by Medicare

b. Medicare Part D patients will have a separate payment for this coverage

c. Medicare Part D cost will vary according to plan and formulary drugs.

d. Medicare Part D is offered through Medicare for prescription coverage. Cost will vary according to the drugs required for the patient.

13.

Which answer is FALSE for Medicaid's "Categorically Needy"?

a. Families that meet TANF eligibility

b. Pregnancy and children under 6 with family income at or below a certain percentage of FPL

c. Caretakers for those under age of 18 and still in highschool

d. Individuals under the age of fifty collecting disability benefits, veteran disability or chronic kidney disease

 

Dedicated to making positive changes in your life and career.