MCBC Medicare Practice Test

These questions are part of the practice quiz. Start practicing

• What are "out-of-pocket maximums" in Medicare Advantage plans?
• Which of the following is NOT a type of review conducted for claims analysis?
• In what situation is it necessary for a provider to issue an ABN?
• What is the primary purpose of the NTE section in the HIPAA 837P?
• How does a recovery auditor approach claims when reviewing payments?
• The Zone Program Integrity Contractors are responsible for audits based on which criteria?
• What is the expected outcome of coinsurance in Medicare?
• What are medically necessary services in Medicare?
• Who runs many of the Medicare coordinated care plans (CCPs)?
• During which scenario might beneficiaries incur the highest potential costs in Medicare?
• What is the primary purpose of the ABN?
• What types of plans might be available in Medicare Advantage?
• What is "shared savings" in relation to Accountable Care Organizations (ACOs)?
• Which type of service would typically require prior authorization under Medicare?
• Which of the following is typically included in prepayment reviews?
• Once the beneficiary reviews and understands the information contained in the ABN, the beneficiary can complete the _____.
• Which of the following best describes the cost-sharing structure in original Medicare?
• What happens to services not clearly documented according to Medicare guidelines in claims?
• What aspect of Medicare requires careful attention by beneficiaries to avoid financial penalties?
• What does "original Medicare" include?
• What are participating providers allowed to discuss with patients regarding Medicare?
• What section of the ABN includes Boxes I-J?
• What is the "Donut Hole" in Medicare Part D?
• What are the primary out-of-pocket expenses associated with original Medicare?
• What is a primary purpose of the Medicare Modernization Act?
• What type of benefits does Medicare Part C primarily offer?
• Which aspect of Medicare does the ABN address?
• What is the coinsurance rate for physicians' services covered under Medicare Part B?
• How much are providers paid by Medicare who elect not to participate in the Medicare program but who accept assignment on a claim?
• What does catastrophic coverage provide in Medicare?
• What does the voluntary ABN replace?
• Which type of information is included in the NTE segment?
• How does Medicare define duplicate claims?
• Which former form does the MSN replace?
• What is the Medicare Part D benefit?
• What is included in the preventive services under Medicare Part B?
• What information is included on the ABN form regarding costs?
• Where can a participating provider locate the Medicare Internet-Only Manuals?
• Why is it essential for beneficiaries to understand the cost-sharing structure of Medicare?
• What is issued when the MAC conducts a medical review and requests additional documentation?
• In what year was the Medicare Modernization Act enacted?
• Which modifier does the principal physician of record typically use with the Evaluation and Management (E/M) code when billed?
• What is the main purpose of screening services in Medicare?
• What is the primary function of the Medicare Integrity Program?
• What effect do paper claims have on cash flow?
• What do ABN modifiers indicate?
• What type of services does the ABN form concern?
• What is the role of deductibles in Medicare services?
• Which insurance type code is used to identify an auto insurance policy as the primary payer?
• What was the reason for replacing the Medicare health insurance claim number (HICN)?
• What date must be reported to Medicare when sharing postoperative care?
• Under the Medicare limiting charges clause, nonPAR providers may not charge a Medicare patient more than _____ percent of the fee listed in the nonPAR MFS.
• What does a premium refer to in the context of Medicare?
• Which of the following is NOT typically covered by a Medicare Advantage Plan?
• Which of the following is true about roster billing?
• When are audits performed for the Medicare recovery auditor program?
• How many blanks are part of the Additional Information section of the ABN?
• Which name was originally used for Medicare Part C?
• What are "Lifetime Reserve Days" in Medicare Part A?
• What kind of preventive services does Medicare cover under Part B?
• How does telehealth fit into Medicare coverage?
• What are the primary components of Medicare Advantage plans?
• Which medical costs are typically covered by Medigap plans?
• How many sections and blanks does the ABN have?
• What benefits does the Medicare Advantage Plus Prescription Drug plan offer?
• What type of services are classified as 'incident-to' under Medicare?
• Which of the following is a covered benefit under Medicare Part B?
• What is "Medicare fraud"?
• What is "step therapy" in the context of medication?
• The Medicare fee-for-service plan is referred to by Medicare as the ___________.
• What term describes services performed for a patient with no current symptoms or history of disease?
• Which of the following expenses might Medicare beneficiaries face when receiving covered services?
• Providers located in HPSAs are eligible for _____ percent bonus payments from Medicare.
• What type of insurance plan may an individual receive when retiring from a company?
• Medicare PAR providers receive payments that are _____ than nonPAR providers.
• What is Medicare Part A primarily designed for?
• What number is issued to providers upon enrollment in the Medicare program?
• The MPFS was developed from the _____ system.
• Which of the following individuals is eligible to receive Medicare benefits?
• Which processes are involved in analyzing data to ensure accurate billing for services?
• What are the payment arrangements for Medicare PAR providers?
• Which of the following statements about Medicare Part B is true?
• Medicare Part B is also referred to as what?
• What are services provided under a physician's direct supervision that can be billed under Medicare called?
• Who is responsible for providing all Medicare-covered services except hospice care in exchange for a predetermined capitated payment?
• How can providers mitigate risks of improper payments in Medicare?
• Who is eligible for Medicare benefits?
• What system do providers use to apply for Medicare participation online?
• Who must fill in the Options Box section on the ABN form?
• How can beneficiaries receive assistance with Medicare questions?
• What does the Medical Savings Account (MSA) pay for under the Medicare Advantage plan?
• Which federal legislation changed the timely filing period for Medicare Part B claims?
• Which legislation created a new plan for Medicare called a Medical Savings Account?
• What is a formulary in relation to Medicare Part D?
• How is eligibility for Medicaid determined?
• Which of the following statements about ZPIC are true?
• What action does a beneficiary take after signing the ABN?
• What is a "Special Enrollment Period" in Medicare?
• What is a significant benefit of choosing a PPO over an HMO in Medicare?
• What does Medicare Part B cover?
• What is the purpose of the Medicare Savings Program?
• What should beneficiaries do if a provider refuses to accept a Medicare patient?
• What does the Medicare Shared Savings Program use to assess PAR providers?
• When did Medicare Part C become effective?
• What is the primary purpose of a Medigap plan?
• Why are recovery auditors important to the Medicare system?
• Who operates the Medicare private fee-for-service plan?
• What is usually a requirement for a Medicare private fee-for-service plan?
• What does "Medically Necessary" mean?
• NonPAR providers decide whether to accept assignment on a ________ basis.
• What factors influence the cost of Medicare Part B premiums?
• When can individuals appeal a denied Medicare claim?
• What is an HPSA?
• What is the primary function of the ABN form?
• What is meant by "exclusion" in Medicare coverage?
• Which part of Medicare is primarily responsible for hospital services?
• Which term best summarizes the payments beneficiaries must make toward covered Medicare services?
• Under a Medicare private fee-for-service plan, patients receive services from _____.
• A retired federal employee over the age of sixty-five who is enrolled in CSRS is eligible for what?
• Individuals aged sixty-five or older eligible for Social Security can enroll in which Medicare Part without premium payments?
• What is the role of Medicare Supplement Insurance?
• What is a consequence for Medicare beneficiaries if they do not enroll during the designated periods?
• What is the name of the simplified billing process for vaccines?
• Which of the following is NOT included in the Local Coverage Determinations (LCDs)?
• Individuals entitled to Medicare Part A benefits are automatically qualified to enroll in which part?
• Which part of the ABN form allows the patient to indicate their decision regarding the service provided?
• Which of the following services is usually covered under Medicare?
• Individuals covered by Medicare Part D are eligible for what type of coverage?
• Which of the following is likely to be monitored by recovery auditors?
• Which of the following are types of plans offered under Medicare Advantage?
• What is a coinsurance payment in Medicare?
• What is the role of Medicare contractors?
• Which sections are part of the ABN?
• What type of providers utilize the ABN form?
• Services that are deemed not to meet certain conditions for coverage are categorized as what?
• If a provider thinks that a procedure will not be covered by Medicare, the patient is notified by means of a(n) _____.
• When are CCI updates typically issued?
• What is a "provider network" in Medicare Advantage plans?
• What are non-participating providers in Medicare?
• Blanks D-F on the ABN form are part of the _____ section.
• According to Medicare guidelines, what should a provider do if a claim has not been paid after thirty days?
• If a patient is covered by both Medicare and a Medigap plan, how many claims are sent to Medicare?
• Approximately how much does Medicare issue in payments each year that led to the enactment of the Medicare Integrity Program?
• Medicare requires the use of which coding system for services?
• Medicare Part A is also known as what?
• What do deductibles refer to in the context of Medicare costs?
• What is the federal medical insurance program established in 1965 under Title XVIII of the Social Security Act?
• What is "open enrollment" for Medicare?
• What are the most restrictive types of plans within the Medicare Coordinated Care Plans?
• What should be appended to CPT/HCPCS codes on Medicare claims when an ABN has been signed?
• What is a network provider in Medicare Advantage plans?
• What can the provider use Blank H for on the ABN?
• What role do "healthcare providers" play in the Medicare system?
• How often do Medicare beneficiaries need to review their plan options?
• What type of benefits do supplemental insurance plans typically provide?
• Where are lab works allowed to be performed according to Medicare regulations?
• What should practices do if covered and noncovered services are performed for a patient on the same date?
• All lab work for Medicare patients is regulated by which rules?
• Which of the following services is NOT typically covered under Medicare Part B?
• How does a Medicare beneficiary report suspected fraud?
• Who are the Medical Advantage plans designed for?
• How can beneficiaries appeal a Medicare coverage decision?
• Which of the following services is excluded under Medicare?
• Select all of the following that are elements on the MSN.
• What will happen to beneficiaries who delay their Medicare enrollment past the designated periods?
• What does selecting OPTION 3 on the ABN signify?
• Which services typically require prior authorization in Medicare Advantage plans?
• Medicare Part C is also known by what other name?
• Why is it important to keep updated contact information with Medicare?
• Which statement accurately describes the role of recovery auditors in the Medicare program?
• How does the 3-day rule affect Medicare coverage?
• What is the importance of the enrollment period for Medicare beneficiaries?
• Who is responsible for issuing the Medicare card to enrollees?
• What triggers the Initial Enrollment Period for Medicare?
• On the ABN form, blanks A-C make up the _____.
• When is an insurance type code required on a claim?
• If a patient has both Medicare and a Medigap plan, what action does Medicare automatically take concerning claims?
• How can beneficiaries avoid penalties associated with Medicare enrollment?
• How is the Medicare Part A premium determined?
• What is "Qualified Medicare Beneficiary (QMB)" status?
• Which of the following types of descriptors may be used in Blank D on the ABN form?
• Which of the following apply only to nonparticipating providers submitting nonassigned claims?
• What must be held longer than electronic claims by law?
• Who manages the Medicare program?
• What is meant by "skilled nursing care" in Medicare?
• Which of the following changes were made to Medicare as a result of the Medicare Modernization Act?
• What should a medical insurance specialist do when Medicare requests a comprehensive medical review?
• Which statement about paper claims is true regarding their payment timeframe?
• How can an individual qualify for Medicare due to disability?
• Which of these statements is true regarding Medicare enrollment?
• What is the written notification called that allows participating providers to bill patients for services excluded from the Medicare program?
• What does dual eligibility refer to in relation to Medicare?
• Which of the following is excluded from Medicare coverage?
• What specific information is required to be submitted to Medicare for postoperative care sharing?
• How do "coinsurance" and "copayment" differ in Medicare?
• What is one effect of not enrolling in Medicare on time?
• What impact does the timing of enrollment have on Medicare beneficiaries?
• Which data elements would be included in PECOS and the CMS 855 form?
• Which statement is true regarding the Medicare recovery auditor program?
• What are private insurance plans that beneficiaries may purchase to cover unpaid amounts in Medicare coverage called?
• Which of the following is considered cost sharing by the beneficiary?
• What does the Medicare assignment code C indicate?
• What legislation primarily determines the services covered under Medicare?
• What is the timely filing period for claims for Part B providers following the Affordable Care Act?
• In 2010, Medicare ceased payment for all consultation CPT codes from which section, excluding G-codes?
• What happens to claims that have invalid or missing diagnosis codes?
• What is preventive screening?
• What entity replaced the Part A fiscal intermediaries and the Part B contractors?
• What does CMS instruct recovery auditors to do when reviewing claims?
• If no NCD applies, MACs may issue _____.
• Who audits claim data on an ongoing basis to check for inappropriate billing under the Medical Review Program?
• Under what condition can an individual enroll in a Medigap policy?
• What percentage of Medicare beneficiaries are under the Original Medicare Plan?
• What is the maximum number of diagnosis codes that can be reported on the HIPAA 837P?
• What is the primary objective of Medicare coverage?
• What does the Medicare assignment code indicate for clinical lab services?
• When is an ABN typically required?
• What does the Medicare Part A deductible refer to?
• Which regulation mandates electronic billing for physician practices with exceptions for smaller offices?
• Under what conditions should practices split the bill when preparing claims?
• Who is responsible for filling out the Header section of the ABN?
• Which of the following is considered a preventive service under Medicare Part B?
• How are services denied under Medicare when they do not meet required standards?
• Which medical staff members are allowed to perform incident-to services?
• What action may trigger a Medicare audit?