CIGNA MEDICARE PRODUCT AND BENEFITS EXAM
ACTUAL EXAM 55 QUESTIONS AND CORRECT
ANSWERS|ALREADY GRADED A+
An individual who is eligible for both Medicaid and Medicare is a______. - ANSWER:
Medi-Medi beneficiary
Medicare Part B deductibles, coinsurance,and some noncovered services can be
covered by buying policies from federally approved private insurance carriers. These
policies are known as_____. - ANSWER: Medigap insurance policies
Claims for Medi-Medi beneficiaries are first submitted to Medicare and then sent to
Medicaid, making them known as_____. - ANSWER: crossover claims
What can a provider earn via the PQRS program? - ANSWER: additional payment
PQRS is a_________. - ANSWER: voluntary program for Medicare
Medicare is the secondary payer when the patient has____. - ANSWER: workers
compensation or federal black lung benefits
What is the Local Coverage Determination (LCD)? - ANSWER: notices sent to
physicians with information about the coding and medical necessity of service
Which option on an ABN allows the beneficiary to receive the non-covered items and
services and pay for them out of pocket? - ANSWER: Option 2
Each calender year, Medicare enrollees must satisfy a_____for covered services
under which Medicare Part B. - ANSWER: deductible
When are physicians required to file claims for their patients who are Medicare
beneficiaries? - ANSWER: if the patients is treated regardless of participation
What do beneficiaries receive to explain the charges paid and due? - ANSWER:
Medicare Summary Notices
Medicare coordinated care plans have which of these disadvantages? - ANSWER:
physician choices limited to those in the particular plans network
The plan that combines a high-deductible fee-for-service plan with a tax-exempt
trust to pay for qualified medical expenses is the_____. - ANSWER: Medical Savings
Account (MSA)
, What national system is based on the resource-Based Relative value Scale (RBRVS)
system using cost factors that represent the physicians time and how much it costs
to run/insure a practice? - ANSWER: Medicare Fee Schedule(MFS)
Physicians who agree to accept assignment for all Medicare claims and to accept
Medicares allowed Charge according to the Medicare Fee Schedule as payment in
full for services are classified as_____. - ANSWER: participating
The Medicare Correct Coding Initiative (CCI) is designed to correct what types of
errors? - ANSWER: both unintentional coding error and intentionally incorrect coding
done to increase payments
Medicare law sets specific guidelines regarding what aspect of submitting claims for
benefits? - ANSWER: timely filing
Under Medicares timely filing guidelines when would the claim for a patient who
received surgery in August of 2014 need to be filed? - ANSWER: on or before August
31, 2015
late claims files with Medicare might still be accepted if a valid explanation is given
such as______. - ANSWER: an unavoidable delay
Before a practice provides an excluded service to a patient the patient may be given
written notification using the CMS form____. - ANSWER: Advance Beneficiary Note
of Noncoverage (ABN)
If a provider thinks a procedure will not be covered by Medicare because it will be
deemed not reasonable and necessary he/she must notify the patient before the
treatment using a standard______. - ANSWER: Advance Beneficiary Notice of
Noncoverage(ABN)
When filling a late claim with Medicare what evidence needs to be sent attached? -
ANSWER: an explanation and evidence to support it
A nonPAR may_____. - ANSWER: accept assignment on a particular claim
Medicare beneficiaries who enroll in the Original Medicare Plan can choose______. -
ANSWER: any licensed certified by Medicare
The amount of a patients medical bills that has been applied to the annual
deductible is shown on the____. - ANSWER: Both MRN and MSN
Medicare coordinated care plans are managed care policies which may offer
beneficiaries which of these advantages: - ANSWER: minimal paperwork
ACTUAL EXAM 55 QUESTIONS AND CORRECT
ANSWERS|ALREADY GRADED A+
An individual who is eligible for both Medicaid and Medicare is a______. - ANSWER:
Medi-Medi beneficiary
Medicare Part B deductibles, coinsurance,and some noncovered services can be
covered by buying policies from federally approved private insurance carriers. These
policies are known as_____. - ANSWER: Medigap insurance policies
Claims for Medi-Medi beneficiaries are first submitted to Medicare and then sent to
Medicaid, making them known as_____. - ANSWER: crossover claims
What can a provider earn via the PQRS program? - ANSWER: additional payment
PQRS is a_________. - ANSWER: voluntary program for Medicare
Medicare is the secondary payer when the patient has____. - ANSWER: workers
compensation or federal black lung benefits
What is the Local Coverage Determination (LCD)? - ANSWER: notices sent to
physicians with information about the coding and medical necessity of service
Which option on an ABN allows the beneficiary to receive the non-covered items and
services and pay for them out of pocket? - ANSWER: Option 2
Each calender year, Medicare enrollees must satisfy a_____for covered services
under which Medicare Part B. - ANSWER: deductible
When are physicians required to file claims for their patients who are Medicare
beneficiaries? - ANSWER: if the patients is treated regardless of participation
What do beneficiaries receive to explain the charges paid and due? - ANSWER:
Medicare Summary Notices
Medicare coordinated care plans have which of these disadvantages? - ANSWER:
physician choices limited to those in the particular plans network
The plan that combines a high-deductible fee-for-service plan with a tax-exempt
trust to pay for qualified medical expenses is the_____. - ANSWER: Medical Savings
Account (MSA)
, What national system is based on the resource-Based Relative value Scale (RBRVS)
system using cost factors that represent the physicians time and how much it costs
to run/insure a practice? - ANSWER: Medicare Fee Schedule(MFS)
Physicians who agree to accept assignment for all Medicare claims and to accept
Medicares allowed Charge according to the Medicare Fee Schedule as payment in
full for services are classified as_____. - ANSWER: participating
The Medicare Correct Coding Initiative (CCI) is designed to correct what types of
errors? - ANSWER: both unintentional coding error and intentionally incorrect coding
done to increase payments
Medicare law sets specific guidelines regarding what aspect of submitting claims for
benefits? - ANSWER: timely filing
Under Medicares timely filing guidelines when would the claim for a patient who
received surgery in August of 2014 need to be filed? - ANSWER: on or before August
31, 2015
late claims files with Medicare might still be accepted if a valid explanation is given
such as______. - ANSWER: an unavoidable delay
Before a practice provides an excluded service to a patient the patient may be given
written notification using the CMS form____. - ANSWER: Advance Beneficiary Note
of Noncoverage (ABN)
If a provider thinks a procedure will not be covered by Medicare because it will be
deemed not reasonable and necessary he/she must notify the patient before the
treatment using a standard______. - ANSWER: Advance Beneficiary Notice of
Noncoverage(ABN)
When filling a late claim with Medicare what evidence needs to be sent attached? -
ANSWER: an explanation and evidence to support it
A nonPAR may_____. - ANSWER: accept assignment on a particular claim
Medicare beneficiaries who enroll in the Original Medicare Plan can choose______. -
ANSWER: any licensed certified by Medicare
The amount of a patients medical bills that has been applied to the annual
deductible is shown on the____. - ANSWER: Both MRN and MSN
Medicare coordinated care plans are managed care policies which may offer
beneficiaries which of these advantages: - ANSWER: minimal paperwork
