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Exam 14: Medicare

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Question 21

Multiple Choice

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A Medicare medical necessity denial is a denial of otherwise covered services that were found to be not __________.

A) cost effective and necessary
B) in compliance with critical pathways
C) necessary and frequent
D) reasonable and necessary

E) A) and B)
F) All of the above

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Question 22

Multiple Choice

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Medicare beneficiaries can also obtain supplemental insurance to help cover costs not reimbursed by the original Medicare plan. This type of coverage is called __________.

A) Medicaid
B) Medicare PLUS
C) Medigap
D) PACE

E) B) and C)
F) None of the above

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Question 23

Multiple Choice

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Which insurance claim is submitted to receive reimbursement under Medicare Part C?

Medicare will award an assigned claim conditional primary payer status and process the claim when a __________.

A simplified roster billing process was developed to enable Medicare beneficiaries to participate in mass __________ programs offered by public health clinics and other entities that bill Medicare payers.

Private fee-for-service (PFFS) plans are offered by private insurance companies in some regions of the country, and Medicare pays a pre-established amount of money each month to the insurance company, which decides how much it will pay for services. Such plans reimburse providers on a fee-for-service basis and are authorized to charge enrollees up to __________ percent of the plan's payment schedule.

Which is a type of HMO that works in much the same way and has some of the same rules as a Medicare Advantage Plan, except that the individual receives health care from a non-network provider, and the original Medicare plan covers the services? The individual pays Medicare Part A and Part B coinsurance and deductibles.

Which is the term for short-term care provided by another caregiver, so the usual caregiver can rest?

Medicare special needs plans cover all Medicare __________ health care services for individuals who can benefit the most from special care for chronic illnesses, care management of multiple diseases, and focused care management.