UHC MEDICARE BASICS TEST EXAM (100 REAL EXAM
QUESTIONS AND CORRECT ANSWERS ) LATEST | AGRADE
When was medicare established? - ANSWER: 1965
Who/What does medicare provide coverage for? - ANSWER: Persons over age 65
Persons disabled for 24+ mo
Persons with end stage renal disease
What is Medicare part A? - ANSWER: Hospital Insurance Program
Provides inpatient services
What is Medicare part B? - ANSWER: Supplementary Medical Insurance Program
Provides outpatient services
What is Medicare Part C? - ANSWER: Medicare Advantage Program
Provides managed care options
What is Medicare Part D? - ANSWER: Medicare Prescription Drug Program
What areas does Medicare Part A cover? - ANSWER: Hospital
Hospice
Long Term Care Hospital
Inpatient Rehab Facility
Skilled Nursing Facility
Home Health
What covers acute hospital coverage? - ANSWER: Diagnosis Related Group (DRG) -
1983
What are some characteristics of DRG? - ANSWER: Payment is made based on dx
Length of stay does NOT impact payment
Goal is to d/c pt to lesser level of care
OT helps determine appropriate d/c plan
T/F: Hospice is a cost-related prospective payment. - ANSWER: True
Is occupational therapy covered under medicare for hospice? - ANSWER: Yes, but
usually only for a few visits
What might medicare cover for occupational therapy during hospice? - ANSWER:
Caregiver Training
Evaluation for adaptive equipment
Manage pain, optimize positioning
, T/F: A patient can be seen under Medicare Part B while on Hospice for a dx that is
different than hospice dx. - ANSWER: True
What are the payment options for a long term care hospital? - ANSWER: Paid by
Prospective Payment System (beginning Oct 2002)
Paid per d/c
Payment system based on LTC-DRGs
What patients typically fall under the payment system based on LTC-DRGs? -
ANSWER: More involved patients/higher acuity level
Ventilator Patients
Wound Patients
What are inpatient rehab facilities reimbursed by? - ANSWER: PPS
What is the major change (as of 10/1/19) in relation to inpatient rehab facilities
(IRF)? - ANSWER: Changed from FIM to GG
What is the inpatient rehab payment system based upon? - ANSWER: CMGs (case
mix groups)
What are CMGs subject to? - ANSWER: the 60% rule
What is the 60% rule? - ANSWER: 60% of patients seen in the IRF just come from 13
diagnostic groups
What is the medicare therapy requirements for OT within the IRF setting? - ANSWER:
Minimum of 3 hours of therapy services a day/15 hours a week from multiple
disciplines (@ least one must be PT/OT)
What are the IRF Dx categories (there are a lot)? - ANSWER: stroke
SCI
Congenital deformity
Amputation
Major multiple trauma
Hip/femur fx
Brain Injury
Neurological disorders
Burns
Some Arthritis conditions (polyarthricular rheumatoid arthritis, psoriatic arthritis,
and seronegative arthropathies)
Systemic vasculidities with joint inflammation
Severe/advanced OA (2+ joints w joint deformity, loss of ROM, and muscle atrophy)
Joint replacement for both knee/hips (surgery immediately precedes admission, BMI
>50, pt older than 85)
QUESTIONS AND CORRECT ANSWERS ) LATEST | AGRADE
When was medicare established? - ANSWER: 1965
Who/What does medicare provide coverage for? - ANSWER: Persons over age 65
Persons disabled for 24+ mo
Persons with end stage renal disease
What is Medicare part A? - ANSWER: Hospital Insurance Program
Provides inpatient services
What is Medicare part B? - ANSWER: Supplementary Medical Insurance Program
Provides outpatient services
What is Medicare Part C? - ANSWER: Medicare Advantage Program
Provides managed care options
What is Medicare Part D? - ANSWER: Medicare Prescription Drug Program
What areas does Medicare Part A cover? - ANSWER: Hospital
Hospice
Long Term Care Hospital
Inpatient Rehab Facility
Skilled Nursing Facility
Home Health
What covers acute hospital coverage? - ANSWER: Diagnosis Related Group (DRG) -
1983
What are some characteristics of DRG? - ANSWER: Payment is made based on dx
Length of stay does NOT impact payment
Goal is to d/c pt to lesser level of care
OT helps determine appropriate d/c plan
T/F: Hospice is a cost-related prospective payment. - ANSWER: True
Is occupational therapy covered under medicare for hospice? - ANSWER: Yes, but
usually only for a few visits
What might medicare cover for occupational therapy during hospice? - ANSWER:
Caregiver Training
Evaluation for adaptive equipment
Manage pain, optimize positioning
, T/F: A patient can be seen under Medicare Part B while on Hospice for a dx that is
different than hospice dx. - ANSWER: True
What are the payment options for a long term care hospital? - ANSWER: Paid by
Prospective Payment System (beginning Oct 2002)
Paid per d/c
Payment system based on LTC-DRGs
What patients typically fall under the payment system based on LTC-DRGs? -
ANSWER: More involved patients/higher acuity level
Ventilator Patients
Wound Patients
What are inpatient rehab facilities reimbursed by? - ANSWER: PPS
What is the major change (as of 10/1/19) in relation to inpatient rehab facilities
(IRF)? - ANSWER: Changed from FIM to GG
What is the inpatient rehab payment system based upon? - ANSWER: CMGs (case
mix groups)
What are CMGs subject to? - ANSWER: the 60% rule
What is the 60% rule? - ANSWER: 60% of patients seen in the IRF just come from 13
diagnostic groups
What is the medicare therapy requirements for OT within the IRF setting? - ANSWER:
Minimum of 3 hours of therapy services a day/15 hours a week from multiple
disciplines (@ least one must be PT/OT)
What are the IRF Dx categories (there are a lot)? - ANSWER: stroke
SCI
Congenital deformity
Amputation
Major multiple trauma
Hip/femur fx
Brain Injury
Neurological disorders
Burns
Some Arthritis conditions (polyarthricular rheumatoid arthritis, psoriatic arthritis,
and seronegative arthropathies)
Systemic vasculidities with joint inflammation
Severe/advanced OA (2+ joints w joint deformity, loss of ROM, and muscle atrophy)
Joint replacement for both knee/hips (surgery immediately precedes admission, BMI
>50, pt older than 85)
