MEDICAL CODING AND BILLING-
CHAPTER 14 QUESTIONS WITH
VERIFIED SOLUTIONS
Participating Providers - answer Contract with insurance to accept
whatever payments they pay.
Non-Participating Providers - answer No contract with insurance
patient pays more out of pocket.
Medicare Administrative Contractors (MAC) - answer Process fee
for service for Medicare Parts A&B and Durable Medical
Equipment (DME).
Private Contractors - answer Contract with insurance to cover and
provide low cost to Medicare Patients.
Roster Billing For Mass Vaccination Programs - answer Public
health clinics that offer various vaccines (e.g. Influenza,
Pneumococcal Polysaccaride), accept assignment for claims on
roster bills to Medicare for payment.
Medicare - answer is a Federal program, maintained by CMS and
basically is divided into four parts. A.B.C.D.
, Medicare Part A - answer Inpatient hospital Care, skilled nursing
facility stays and some home health services.
Medicare Part B - answer Outpatient hospital care, durable
medical equipment, physicians for inpatient and office services
sand some services not covered by Part A.
Medicare Part C - answer Provide options for prescription coverage
and lowers cost to patients. They are managed by Medicare
approved private contractors.
Medicare Part D - answer Prescription Drug Plan
Donut Hole - answer states that patient will pay 50% of
medication price until donut hole is implemented in 2020.
Medigap (Supplemental Plan) - answer Allows patient to obtain
this plan to help cover cost not covered by Medicare.
Medicare eligibility - answer a)- individual or spouse to have been
employed at least 10 years in Medicare covered employment
plan.
b) - Individuals to be minimum of 65 years old and must be
Citizen or green card resident.
c) - individuals under 65 if have disability or end stage renal
disease.
d) - if meet disability requirements (unable to work) there is no
premium for Part A, but must pay premium for Part B.
CHAPTER 14 QUESTIONS WITH
VERIFIED SOLUTIONS
Participating Providers - answer Contract with insurance to accept
whatever payments they pay.
Non-Participating Providers - answer No contract with insurance
patient pays more out of pocket.
Medicare Administrative Contractors (MAC) - answer Process fee
for service for Medicare Parts A&B and Durable Medical
Equipment (DME).
Private Contractors - answer Contract with insurance to cover and
provide low cost to Medicare Patients.
Roster Billing For Mass Vaccination Programs - answer Public
health clinics that offer various vaccines (e.g. Influenza,
Pneumococcal Polysaccaride), accept assignment for claims on
roster bills to Medicare for payment.
Medicare - answer is a Federal program, maintained by CMS and
basically is divided into four parts. A.B.C.D.
, Medicare Part A - answer Inpatient hospital Care, skilled nursing
facility stays and some home health services.
Medicare Part B - answer Outpatient hospital care, durable
medical equipment, physicians for inpatient and office services
sand some services not covered by Part A.
Medicare Part C - answer Provide options for prescription coverage
and lowers cost to patients. They are managed by Medicare
approved private contractors.
Medicare Part D - answer Prescription Drug Plan
Donut Hole - answer states that patient will pay 50% of
medication price until donut hole is implemented in 2020.
Medigap (Supplemental Plan) - answer Allows patient to obtain
this plan to help cover cost not covered by Medicare.
Medicare eligibility - answer a)- individual or spouse to have been
employed at least 10 years in Medicare covered employment
plan.
b) - Individuals to be minimum of 65 years old and must be
Citizen or green card resident.
c) - individuals under 65 if have disability or end stage renal
disease.
d) - if meet disability requirements (unable to work) there is no
premium for Part A, but must pay premium for Part B.
