MEDICARE LATEST EXAM ACTUAL QUESTIONS AND
ANSWERS RATED A+
✔✔The maximum that Medicare will reimburse a nonPAR for a covered service is 80
percent of the - ✔✔limiting charge
✔✔The maximum fee a provider a provider may charge is called - ✔✔limiting charge
✔✔Dr. Taylor has instructed you, as a health insurance specialist, to obtain an Advance
Beneficiary Notice (ABN) on all surgical cases in the practice just in case Medicare
denies the claim. How should you handle this situation? - ✔✔Explain to Dr. Taylor that
the practice cannot do this, as Medicare considers this activity fraudulent
✔✔What is entered in Block 11 of the CMS-1500 claim when a reference lab provides
services to Medicare patient in the absence of a face-to-face encounter? - ✔✔NONE
✔✔Although they may do so more frequently, how often are providers required to
collect or verify Medicare as Secondary Payer (MSP) information? - ✔✔at the time of
the initial beneficiary encounter only
✔✔Medicare can assign a claim conditional primary payer status for payment
processing. Which of the following would warrant this type of conditional status - ✔✔a
patient who is mentally impaired failed to file a claim with the primary payer
✔✔If a service was prepared on June 30, the Medicare claim must be submitted for
payment and postmarked no later than - ✔✔June 30 of the next year
✔✔Who created Medicare? - ✔✔By Congress Social Security Act in 1965 (Title XVIII)
✔✔A Federal Program authorized by Congress and administered by the Centers for
Medicare and Medicaid Services (CMS) - ✔✔Medicare
✔✔Medicare is a health care benefit program for - ✔✔people 65 years of age and older,
people under age 65 with certain disabilities, and people with end-stage renal disease
(ESRD)
✔✔The Original Medicare Plan consisted of - ✔✔Part A, Part B, and Part D
✔✔The four parts of Medicare are - ✔✔Part A (hospital admission), Part B (medical
insurance), Part C (medicare advantage plans and includes Part A & B, and sometimes
D), and Part D (prescription drug coverage)
, ✔✔Covered basics include inpatient hospital care, skilled nursing care, some home
health care, and hospice care - ✔✔Medicare Part A
✔✔Covered basics include doctor's services and outpatient care, preventive services,
diagnostic tests, some therapies, and durable medical equipment - ✔✔Medicare Part B
✔✔Covered basics include outpatient prescription drugs - ✔✔Medicare Part D
✔✔Formerly called Medicare + Choice, includes managed care and private fee-for-
service plans that provided contracted care to Medicare patients - ✔✔Medicare
Advantage
✔✔What is required to have Medicare Part C? - ✔✔Beneficiary must have both Parts A
and B
✔✔What are Medicare Advantage plans? - ✔✔Medicare Part C; Medicare contracts
with private companies to offer plans to Medicare beneficiaries, includes Part A and Part
B benefits
✔✔HMO, PPO, Private fee-for-service (PFFS), medical savings account (MSA), and
Special needs plan - ✔✔types of Medicare Advantage plans
✔✔Individuals entitled to Medicare and eligible for some type of Medicaid benefit -
✔✔duel eligibles
✔✔Helps individuals whose assets are not low enough to quality them for Medicaid by
requiring states to pay their Medicare Part A and B premiums, deductibles, and
coinsurance amounts - ✔✔Qualified Medicare beneficiary program (QMBP)
✔✔Helps low-income individuals by requiring states to pay their Medicare Part B
premiums - ✔✔Specified Low-Income Medicare beneficiary (SLMB)
✔✔Helps low-income individuals by requiring states to pay their Medicare Part B
premiums - ✔✔Qualifying individual (QI-1)
✔✔Begins with the first day of hospitalization and ends when the patient has been out
of the hospital for 60 consecutive days - ✔✔benefit period or spell of illness
✔✔May be used only once during a patient's lifetime and are usually reserved for use
during the patient's final, terminal hospital stay - ✔✔lifetime reserve days (60 days)
✔✔Based on Relative Value Units (RVUs) that consider resources used in providing a
service - ✔✔physician fee schedule
ANSWERS RATED A+
✔✔The maximum that Medicare will reimburse a nonPAR for a covered service is 80
percent of the - ✔✔limiting charge
✔✔The maximum fee a provider a provider may charge is called - ✔✔limiting charge
✔✔Dr. Taylor has instructed you, as a health insurance specialist, to obtain an Advance
Beneficiary Notice (ABN) on all surgical cases in the practice just in case Medicare
denies the claim. How should you handle this situation? - ✔✔Explain to Dr. Taylor that
the practice cannot do this, as Medicare considers this activity fraudulent
✔✔What is entered in Block 11 of the CMS-1500 claim when a reference lab provides
services to Medicare patient in the absence of a face-to-face encounter? - ✔✔NONE
✔✔Although they may do so more frequently, how often are providers required to
collect or verify Medicare as Secondary Payer (MSP) information? - ✔✔at the time of
the initial beneficiary encounter only
✔✔Medicare can assign a claim conditional primary payer status for payment
processing. Which of the following would warrant this type of conditional status - ✔✔a
patient who is mentally impaired failed to file a claim with the primary payer
✔✔If a service was prepared on June 30, the Medicare claim must be submitted for
payment and postmarked no later than - ✔✔June 30 of the next year
✔✔Who created Medicare? - ✔✔By Congress Social Security Act in 1965 (Title XVIII)
✔✔A Federal Program authorized by Congress and administered by the Centers for
Medicare and Medicaid Services (CMS) - ✔✔Medicare
✔✔Medicare is a health care benefit program for - ✔✔people 65 years of age and older,
people under age 65 with certain disabilities, and people with end-stage renal disease
(ESRD)
✔✔The Original Medicare Plan consisted of - ✔✔Part A, Part B, and Part D
✔✔The four parts of Medicare are - ✔✔Part A (hospital admission), Part B (medical
insurance), Part C (medicare advantage plans and includes Part A & B, and sometimes
D), and Part D (prescription drug coverage)
, ✔✔Covered basics include inpatient hospital care, skilled nursing care, some home
health care, and hospice care - ✔✔Medicare Part A
✔✔Covered basics include doctor's services and outpatient care, preventive services,
diagnostic tests, some therapies, and durable medical equipment - ✔✔Medicare Part B
✔✔Covered basics include outpatient prescription drugs - ✔✔Medicare Part D
✔✔Formerly called Medicare + Choice, includes managed care and private fee-for-
service plans that provided contracted care to Medicare patients - ✔✔Medicare
Advantage
✔✔What is required to have Medicare Part C? - ✔✔Beneficiary must have both Parts A
and B
✔✔What are Medicare Advantage plans? - ✔✔Medicare Part C; Medicare contracts
with private companies to offer plans to Medicare beneficiaries, includes Part A and Part
B benefits
✔✔HMO, PPO, Private fee-for-service (PFFS), medical savings account (MSA), and
Special needs plan - ✔✔types of Medicare Advantage plans
✔✔Individuals entitled to Medicare and eligible for some type of Medicaid benefit -
✔✔duel eligibles
✔✔Helps individuals whose assets are not low enough to quality them for Medicaid by
requiring states to pay their Medicare Part A and B premiums, deductibles, and
coinsurance amounts - ✔✔Qualified Medicare beneficiary program (QMBP)
✔✔Helps low-income individuals by requiring states to pay their Medicare Part B
premiums - ✔✔Specified Low-Income Medicare beneficiary (SLMB)
✔✔Helps low-income individuals by requiring states to pay their Medicare Part B
premiums - ✔✔Qualifying individual (QI-1)
✔✔Begins with the first day of hospitalization and ends when the patient has been out
of the hospital for 60 consecutive days - ✔✔benefit period or spell of illness
✔✔May be used only once during a patient's lifetime and are usually reserved for use
during the patient's final, terminal hospital stay - ✔✔lifetime reserve days (60 days)
✔✔Based on Relative Value Units (RVUs) that consider resources used in providing a
service - ✔✔physician fee schedule
