IHMO Ch. 12 Review Questions With Complete Solutions
___ is a specialized Medicare supplemental insurance policy
whose predefined minimum benefits are regulated by the federal
government and devised for the Medicare beneficiary. Correct
Answers Medigap (MG)
___ is a stand-alone drug plan, presented by insurance and other
private companies that offer drug coverage that meets the
standards established by Medicare. Correct Answers Medicare
Part D Prescription Drug Plan
A Centers for Medicare and Medicaid Services (CMS)-assigned
provider identification number is known
as a/an ____. Correct Answers National Provider Identifier
(NPI).
A claims assistance professional (CAP) ___. Correct Answers
may act on the Medicare beneficiary's behalf as a client
representative.
A decision by a Medicare administrative contractor (MAC)
whether to cover (pay) a particular medical
service on a contractor-wide basis in accordance with whether it
is reasonable and necessary is known
as a/an ___ Correct Answers Local Coverage Determination.
A Medicare insurance claim form showed a number, J0540, for
an injection of 600,000 U of penicillin G. This number is
referred to as a/an ___. Correct Answers Healthcare Common
Procedure Coding System (HCPCS) Level II code number.
, A Medicare non participating physician may bill no more than
the Medicare ___. Correct Answers Lending Charge
A Medicare prepayment screen ___. Correct Answers
identifies claims to review for medical necessity.
A participating physician with the Medicare plan agrees to
accept ___. Correct Answers 80% of the Medicare-approved
charge.
A program designed to provide pain relief, symptom
management, and supportive services to terminally ill
individuals and their families is known as ___. Correct Answers
hospice
A specialized insurance policy that is predefined by the federal
government for the Medicare beneficiary to cover the deductible
and copayment amounts is referred to as ___. Correct Answers
Premium
A state-based group of doctors working under government
guidelines reviewing cases for hospital admission and discharge
is known as a ___. Correct Answers QIO
Acceptance of assignment by a participating physician means
that he or she agrees to ___ after the $___ annual deductible has
been met. Correct Answers accept payment from Medicare
(80% of the approved charges) plus payment from the patient
(20% of the approved charges) ; $135 .
___ is a specialized Medicare supplemental insurance policy
whose predefined minimum benefits are regulated by the federal
government and devised for the Medicare beneficiary. Correct
Answers Medigap (MG)
___ is a stand-alone drug plan, presented by insurance and other
private companies that offer drug coverage that meets the
standards established by Medicare. Correct Answers Medicare
Part D Prescription Drug Plan
A Centers for Medicare and Medicaid Services (CMS)-assigned
provider identification number is known
as a/an ____. Correct Answers National Provider Identifier
(NPI).
A claims assistance professional (CAP) ___. Correct Answers
may act on the Medicare beneficiary's behalf as a client
representative.
A decision by a Medicare administrative contractor (MAC)
whether to cover (pay) a particular medical
service on a contractor-wide basis in accordance with whether it
is reasonable and necessary is known
as a/an ___ Correct Answers Local Coverage Determination.
A Medicare insurance claim form showed a number, J0540, for
an injection of 600,000 U of penicillin G. This number is
referred to as a/an ___. Correct Answers Healthcare Common
Procedure Coding System (HCPCS) Level II code number.
, A Medicare non participating physician may bill no more than
the Medicare ___. Correct Answers Lending Charge
A Medicare prepayment screen ___. Correct Answers
identifies claims to review for medical necessity.
A participating physician with the Medicare plan agrees to
accept ___. Correct Answers 80% of the Medicare-approved
charge.
A program designed to provide pain relief, symptom
management, and supportive services to terminally ill
individuals and their families is known as ___. Correct Answers
hospice
A specialized insurance policy that is predefined by the federal
government for the Medicare beneficiary to cover the deductible
and copayment amounts is referred to as ___. Correct Answers
Premium
A state-based group of doctors working under government
guidelines reviewing cases for hospital admission and discharge
is known as a ___. Correct Answers QIO
Acceptance of assignment by a participating physician means
that he or she agrees to ___ after the $___ annual deductible has
been met. Correct Answers accept payment from Medicare
(80% of the approved charges) plus payment from the patient
(20% of the approved charges) ; $135 .
