Question 1

The Medicare program

Accepted Answer

A)   employs MACs to pay the Medicare beneficiary.
B)   directly pays the Medicare beneficiary.
C)   directly pays the claims submitted by providers.
D)   employs MACs to pay the claims submitted by providers.E) None of the above
F) A) and D)

Question 2

Anyone over age 65 who receives Social Security benefits is automatically

Accepted Answer

A)   enrolled in Medicare Part A and eligible for Medicare Part B.
B)   neither enrolled in Medicare Part A nor eligible for Medicare Part B.
C)   eligible for Medicare Part B.
D)   enrolled in Medicare Part A.E) C) and D)
F) B) and D)

Question 3

The limiting charge under the Medicare program can be billed by

Accepted Answer

A)   either participating or nonparticipating providers.
B)   participating providers only.
C)   neither participating or nonparticipating providers.
D)   nonparticipating providers only.E) B) and C)
F) A) and C)

Question 4

ABN is the abbreviation for

Accepted Answer

A)   Advance Beneficiary Notice.
B)   Annual Beneficiary Notice.
C)   Applicable Beneficiary Notice.
D)   Absolute Beneficiary Notice.E) A) and B)
F) All of the above

Question 5

The modifier GY is appended to procedure codes for noncovered Medicare services when

Accepted Answer

A)   the item is expected to be denied as not reasonable but there is not a signed ABN.
B)   the item is expected to be denied but there is a signed ABN.
C)   the item is expected to be paid in full.
D)   the item is excluded and an ABN is not required.E) A) and B)
F) None of the above

Question 6

What percentage of the fee on the Medicare nonPAR Fee Schedule is the limiting charge?

Accepted Answer

A)   80 percent
B)   85 percent
C)   100 percent
D)   115 percentE) A) and B)
F) None of the above D

Question 7

Telehealth consultations should be assigned a code from which section for Medicare beneficiaries?

Accepted Answer

A)   CPT Evaluation and Management
B)   determined by the circumstance around that telehealth consultation
C)   HCPCS G-codes
D)   ICD-10-PCSE) A) and B)
F) B) and D)

Question 8

Medicare Administrative Contractors (MACs)  process Medicare claims for which of the following?

Accepted Answer

A)   None of these is correct
B)   Medicare beneficiaries
C)   Medigap holders
D)   BCBS policy holdersE) None of the above
F) B) and D) B

Question 9

E/M services during a global period that are unrelated to the procedure can be billed with what modifier?

Accepted Answer

A)   -25
B)   -59
C)   -24
D)   -51E) A) and D)
F) A) and B)

Question 10

In what year did Medicare stop paying for all consultation codes from the CPT evaluation and management, except for telehealth consultation G-codes?

Accepted Answer

A)   2012
B)   2005
C)   2010
D)   2000E) B) and C)
F) None of the above

Question 11

Patients receive a __________ that details the services they were provided over a thirty-day period, the amounts charged, and the amounts they may be billed.

Accepted Answer

A)   Medicare Summary Notice
B)   Medicare Statement
C)   Medicare Notice
D)   Medicare Statement NoticeE) A) and B)
F) A) and C)

Question 12

Providers located in areas designated by Medicare as HPSAs are eligible for __________ bonus payments from Medicare.

Accepted Answer

A)   15%
B)   10%
C)   2.5%
D)   5%E) None of the above
F) A) and B)

Question 13

The Medicare limiting charge is the __________ fee that can be charged for a procedure by a nonparticipating provider.

Accepted Answer

A)   highest
B)   flexible
C)   rotating
D)   lowestE) B) and D)
F) B) and C)

Question 14

Which of the following statements is correct?

Accepted Answer

A)   Physicians must accept Medicare patients, per federal statute.
B)   Physicians who participate in Medicare may decide whether to accept assignment on a claim-by-claim basis.
C)   Physicians who do not participate in Medicare may decide whether to accept assignment on a claim-by-claim basis.
D)   Physicians will receive the same amount of reimbursement regardless if they participate in the Medicare program or not.E) C) and D)
F) B) and D)

Question 15

A program that provides incentives for physicians for reporting on quality of care performance measures is called

Accepted Answer

A)   Advance Beneficiary Notice.
B)   Notice of Exclusions from Medicare Benefits.
C)   False Claim Act Notice.
D)   Quality Payment Program.E) A) and B)
F) B) and D)

Question 16

Supplemental insurance plans for Medicare beneficiaries provide additional coverage for an individual receiving benefits under which Medicare Part?

Accepted Answer

A)   Medicare Part B
B)   Medicare Part C
C)   Medicare Part A
D)   Medicare Part DE) B) and C)
F) None of the above

Question 17

People who are over age 65 but who are not eligible for free Part A coverage may enroll by

Accepted Answer

A)   paying a premium.
B)   enrolling in a Medicare HMO.
C)   paying a deductible.
D)   paying into a Medical Savings Account.E) B) and D)
F) A) and B)

Question 18

Medicare Part B beneficiaries pay a monthly premium that is calculated based on which of the following?

Accepted Answer

A)   Social Security benefit rates
B)   income
C)   part B does not have a monthly premium
D)   ageE) A) and D)
F) None of the above A

Question 19

If a Medicare PAR physician thinks that a planned procedure will not be found medically necessary by Medicare and so will not be reimbursed, the patient should be asked to sign a(n)

Accepted Answer

A)   Medicare waiver.
B)   advance beneficiary notice.
C)   notice of exclusions from Medicare benefits.
D)   Medicare Summary Notice.E) None of the above
F) B) and C)

Question 20

Roster billing applies to which Part of Medicare?

Accepted Answer

A)   Medicare Part C
B)   Medicare Part D
C)   Medicare Part B
D)   Medicare Part AE) A) and C)
F) A) and B)

Exam 9: Medicare

The Medicare program

Correct AnswerverifiedShow Answer

Anyone over age 65 who receives Social Security benefits is automatically

Correct AnswerverifiedShow Answer

The limiting charge under the Medicare program can be billed by

Correct AnswerverifiedShow Answer

ABN is the abbreviation for

Correct AnswerverifiedShow Answer

The modifier GY is appended to procedure codes for noncovered Medicare services when

Correct AnswerverifiedShow Answer

What percentage of the fee on the Medicare nonPAR Fee Schedule is the limiting charge?

Correct AnswerverifiedD

Telehealth consultations should be assigned a code from which section for Medicare beneficiaries?

Correct AnswerverifiedShow Answer

Medicare Administrative Contractors (MACs) process Medicare claims for which of the following?

Correct AnswerverifiedB

E/M services during a global period that are unrelated to the procedure can be billed with what modifier?

Correct AnswerverifiedShow Answer

In what year did Medicare stop paying for all consultation codes from the CPT evaluation and management, except for telehealth consultation G-codes?

Correct AnswerverifiedShow Answer

Patients receive a __________ that details the services they were provided over a thirty-day period, the amounts charged, and the amounts they may be billed.

Correct AnswerverifiedShow Answer

Providers located in areas designated by Medicare as HPSAs are eligible for __________ bonus payments from Medicare.

Correct AnswerverifiedShow Answer

The Medicare limiting charge is the __________ fee that can be charged for a procedure by a nonparticipating provider.

Correct AnswerverifiedShow Answer

Which of the following statements is correct?

Correct AnswerverifiedShow Answer

A program that provides incentives for physicians for reporting on quality of care performance measures is called

Correct AnswerverifiedShow Answer

Supplemental insurance plans for Medicare beneficiaries provide additional coverage for an individual receiving benefits under which Medicare Part?

Correct AnswerverifiedShow Answer

People who are over age 65 but who are not eligible for free Part A coverage may enroll by

Correct AnswerverifiedShow Answer

Medicare Part B beneficiaries pay a monthly premium that is calculated based on which of the following?

Correct AnswerverifiedA

If a Medicare PAR physician thinks that a planned procedure will not be found medically necessary by Medicare and so will not be reimbursed, the patient should be asked to sign a(n)

Correct AnswerverifiedShow Answer

Roster billing applies to which Part of Medicare?

Correct AnswerverifiedShow Answer

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D

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B

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A

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