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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.

The physician bills for a procedure in the amount of $100.00. Medicare allows $80.00 and the patient is responsible for 20% of the allowable. How much is paid to the physician by Medicare?

a. 84

b. 16

c. 64

d. 20

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.

Medicare patient is brought into Emergency Room and then admitted to the hospital with a hip fracture.  The patient fell on ice at a friends home.  How is this properly billed to Medicare?

a. Medicare insurance is billed first and personal property insurance is billed second. The patient cannot be held responsible for any deductibles or coinsurance due to third party liability.

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

c. Since Medicare is a federally funded program, only Medicare can be billed and patient is responsible for deductibles, coinsurance and 20% of what Medicare allows.

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.

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.

Patient is seen for her first time at the podiatrist for nail debridement and removal of corns. She is informed that Medicare will not pay for this service. Patient is convinced Medicare will pay for the service but signs ABN to proceed with the procedure knowing she could be responsible to pay $134.00.  How is this procedure billed to Medicare and how will Medicare process the claim?

a. GA modifier is added to the procedure code. Medicare will process the claim informing the patient the procedure is not covered and they are not responsible for the $134.00.

b. GX modifier is added to the procedure code. Medicare will process the claim informing the patient the procedure is not covered and they are responsible for the $134.00.

c. GY modifier is added to the procedure code verses GA and Medicare will pay 80% of the allowable and patient is responsible for 20%.

d. TS and GX is added to procedure because it is a follow-up visit and may be paid by Medicare.

12.

What is the Medicare Part a deductible amount for 2019?

a. $135.50

b. $1364.00

c. $185.00

d. $341.00/day for first 30 days

13.

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.

14.

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.

 

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