MEDICARE STUDY EXAMS GUIDE QUESTIONS AND
ANSWERS RATED A+
✔✔Commercial or private insurance provides secondary or supplemental
reimbursement for out-of-pocket costs not covered by Medicare - ✔✔medigap
✔✔When Medicare is secondary to a primary plan (Group Health), it's referred to as -
✔✔Medicare secondary payer
✔✔Balance billing of the patient by a non-PAR is - ✔✔forbidden
✔✔Nonparticipating physicians who do not accept assignment on Medicare claims are
subject to a __________________ (established by federal law) on what can be charged
to beneficiaries - ✔✔limit
✔✔The Medicare-allowed fee for non-PAR is _______ percent below the PAR fee
schedule - ✔✔five
✔✔The non-PAR physician may charge a maximum of ______ percent above the non-
PAR approved rate (or _______ percent above the PAR fee schedule)> - ✔✔15, 10
✔✔A written document provided to a Medicare beneficiary by a supplier, physician, or
provider prior to service being rendered; indicates that the service is unlikely to be
reimbursed by Medicare - ✔✔Advance Beneficiary Notice (ABN)
✔✔Federal law requires that all providers and suppliers submit claims to Medicare if
they provide a Medicare-covered service to a patient enrolled in Medicare Part B -
✔✔Mandatory Claims Submission
✔✔ If a patient has retiree group health plan coverage (including from his spouse's
former employment), the group health plan pays - ✔✔first
✔✔What is the name of the monthly explanation of benefits statement that Medicare
patient's receive? - ✔✔Medicare summary notice
✔✔Which is a characteristic of Medicare enrollment? - ✔✔Eligible individuals are
automatically enrolled, or they apply for coverage
✔✔Which processes traditional Medicare claims? - ✔✔Medicare administrative
contractor
✔✔Skilled nursing facility (SNF) inpatients who meet Medicare's qualified diagnosis and
comprehensive treatment plan requirements when they are admitted after a three-day-
, minimum acute hospital stay are required to pay the Medicare rate for SNF inpatient
care during which period? - ✔✔days 101+
✔✔Which is the total number of Medicare lifetime reserve days (defined as the number
of days that can be used just once during a patient's lifetime)? - ✔✔60
✔✔The Original Medicare Plan is also called Medicare - ✔✔fee-for-service
✔✔system in which a bill is generated and a fee is paid every time a provider does
something for a patient - ✔✔Fee-for-service
✔✔Medigap coverage is offered to Medicare beneficiaries by - ✔✔commercial payers
✔✔Supplemental plans designed by the federal government but sold by private
commercial insurance companies to cover the costs of Medicare deductibles,
copayments, and coinsurance, which are considered "gaps" in Medicare coverage -
✔✔medigap
✔✔Maximum fee a provider may charge - ✔✔limiting charge
✔✔A Medicare nonparticipating provider is not allowed to - ✔✔utilize balance billing
(forbidden)
✔✔Which is a written document provided to a Medicare beneficiary by a provider prior
to rendering a service that is unlikely to be reimbursed by Medicare? - ✔✔advance
beneficiary notice of noncoverage
✔✔Medicare Part A coverage is available to individuals under the age of 65 who -
✔✔have end-stage renal disease and meet requirements
✔✔Which information must be obtained about the beneficiary to confirm Medicare
eligibility over the phone? - ✔✔date of birth
✔✔What length of time is the Medicare initial enrollment period (IEP)? - ✔✔seven
months
✔✔The Medicare "spell of illness" is also known as the - ✔✔benefit period
✔✔Patients may elect to use their Medicare lifetime reserve days after how many
continuous days of hospitalization? - ✔✔90
✔✔For a beneficiary to qualify for Medicare's skilled nursing benefit the individual must
have - ✔✔had at least three inpatient days of an acute hospital stay
ANSWERS RATED A+
✔✔Commercial or private insurance provides secondary or supplemental
reimbursement for out-of-pocket costs not covered by Medicare - ✔✔medigap
✔✔When Medicare is secondary to a primary plan (Group Health), it's referred to as -
✔✔Medicare secondary payer
✔✔Balance billing of the patient by a non-PAR is - ✔✔forbidden
✔✔Nonparticipating physicians who do not accept assignment on Medicare claims are
subject to a __________________ (established by federal law) on what can be charged
to beneficiaries - ✔✔limit
✔✔The Medicare-allowed fee for non-PAR is _______ percent below the PAR fee
schedule - ✔✔five
✔✔The non-PAR physician may charge a maximum of ______ percent above the non-
PAR approved rate (or _______ percent above the PAR fee schedule)> - ✔✔15, 10
✔✔A written document provided to a Medicare beneficiary by a supplier, physician, or
provider prior to service being rendered; indicates that the service is unlikely to be
reimbursed by Medicare - ✔✔Advance Beneficiary Notice (ABN)
✔✔Federal law requires that all providers and suppliers submit claims to Medicare if
they provide a Medicare-covered service to a patient enrolled in Medicare Part B -
✔✔Mandatory Claims Submission
✔✔ If a patient has retiree group health plan coverage (including from his spouse's
former employment), the group health plan pays - ✔✔first
✔✔What is the name of the monthly explanation of benefits statement that Medicare
patient's receive? - ✔✔Medicare summary notice
✔✔Which is a characteristic of Medicare enrollment? - ✔✔Eligible individuals are
automatically enrolled, or they apply for coverage
✔✔Which processes traditional Medicare claims? - ✔✔Medicare administrative
contractor
✔✔Skilled nursing facility (SNF) inpatients who meet Medicare's qualified diagnosis and
comprehensive treatment plan requirements when they are admitted after a three-day-
, minimum acute hospital stay are required to pay the Medicare rate for SNF inpatient
care during which period? - ✔✔days 101+
✔✔Which is the total number of Medicare lifetime reserve days (defined as the number
of days that can be used just once during a patient's lifetime)? - ✔✔60
✔✔The Original Medicare Plan is also called Medicare - ✔✔fee-for-service
✔✔system in which a bill is generated and a fee is paid every time a provider does
something for a patient - ✔✔Fee-for-service
✔✔Medigap coverage is offered to Medicare beneficiaries by - ✔✔commercial payers
✔✔Supplemental plans designed by the federal government but sold by private
commercial insurance companies to cover the costs of Medicare deductibles,
copayments, and coinsurance, which are considered "gaps" in Medicare coverage -
✔✔medigap
✔✔Maximum fee a provider may charge - ✔✔limiting charge
✔✔A Medicare nonparticipating provider is not allowed to - ✔✔utilize balance billing
(forbidden)
✔✔Which is a written document provided to a Medicare beneficiary by a provider prior
to rendering a service that is unlikely to be reimbursed by Medicare? - ✔✔advance
beneficiary notice of noncoverage
✔✔Medicare Part A coverage is available to individuals under the age of 65 who -
✔✔have end-stage renal disease and meet requirements
✔✔Which information must be obtained about the beneficiary to confirm Medicare
eligibility over the phone? - ✔✔date of birth
✔✔What length of time is the Medicare initial enrollment period (IEP)? - ✔✔seven
months
✔✔The Medicare "spell of illness" is also known as the - ✔✔benefit period
✔✔Patients may elect to use their Medicare lifetime reserve days after how many
continuous days of hospitalization? - ✔✔90
✔✔For a beneficiary to qualify for Medicare's skilled nursing benefit the individual must
have - ✔✔had at least three inpatient days of an acute hospital stay
