Medicare Flashcards Chapter 10

Questions and Answers

Anyone over age 65 who receives social security benefits is automatically enrolled in__________.

Medicare parts A and B

People over age 65 but who are not eligible for free part A coverage may enroll by__________.

paying a premium

Retired federal employees who are enrolled in the civil service retirement system are eligible for Medicare benefits and their spouses.

True

_____ is also called hospital insurance.

Medicare part A Signup and view all the answers

Care in a skilled nursing facility is covered under __________.

Medicare part A Signup and view all the answers

______ was originally called Medicare+Choice.

Medicare part C Signup and view all the answers

_____ provides voluntary Medicare prescription drug plans.

Medicare part D Signup and view all the answers

Each Medicare enrollee receives a ____ issued by the Social Security Administration.

Medicare card Signup and view all the answers

CWF is the abbreviation for?

common working file Signup and view all the answers

Medicare part B does not provide benefits for __________.

cosmetic surgery Signup and view all the answers

_______ is performed for a patient who does not have symptoms, abnormal findings, or any past history of the disease.

screening services Signup and view all the answers

ABN is the abbreviation for?

advance beneficiary notification Signup and view all the answers

The modifier GY is appended to procedure codes for non-covered Medicare services when __________.

the item is excluded and an ABN is not required Signup and view all the answers

Physicians who do not participate in the Medicare program do not accept the Medicare fee schedule charge amount as __________.

full payment for services Signup and view all the answers

___ of the fee on the Medicare NONPAR fee schedule equals the limiting charge.

115% Signup and view all the answers

Under the Medicare program, a nonparticipating physician may not bill more than 115% of __________.

the approved charge on the NONPAR fee schedule Signup and view all the answers

The Medicare limiting charge is the highest fee that can be charged for a __________.

procedure by a nonparticipating provider Signup and view all the answers

Patients receive a _____ that details the services they were provided over a thirty-day period, the amounts charged, and the amounts they may be billed.

Medicare summary notice (MSM) Signup and view all the answers

Medicare advantage offers three types of plans including __________.

Medicare private fee for service plans, Medicare coordinated care plans (CCP), and Medicare savings accounts (MSA) Signup and view all the answers

Urgently needed care is defined in the Medicare program as?

unexpected illness or injury that requires immediate treatment Signup and view all the answers

A medigap plan offers __________.

fill-in-the-gap insurance Signup and view all the answers

All laboratory work paid for by __________.

Medicare is regulated by CLIA rules Signup and view all the answers

CLIA is administered by?

CMS Signup and view all the answers

Roster billing applies __________.

to part B claims Signup and view all the answers

Services supervised by the physician but provided by non-physician practitioners are billed under __________.

incident-to rules Signup and view all the answers

Study Notes

Medicare Overview

Individuals over age 65 who receive Social Security benefits are automatically enrolled in Medicare Parts A and B.
Those over age 65 not eligible for free Part A can enroll by paying a premium.

Medicare Benefits and Coverage

Retired federal employees under the Civil Service Retirement System are eligible for Medicare benefits for themselves and spouses.
Medicare Part A is referred to as hospital insurance and covers care in skilled nursing facilities.
Medicare Part C, initially known as Medicare+Choice, encompasses various managed care plans.
Medicare Part D offers voluntary prescription drug plans to enrollees.

Medicare Documentation and Notifications

Each Medicare enrollee receives a Medicare card issued by the Social Security Administration.
Common Working File (CWF) is the system used for managing Medicare claims.
Advance Beneficiary Notification (ABN) informs beneficiaries about non-covered services.

Billing and Charges

Medicare Part B does not cover cosmetic surgery procedures.
Screening services are conducted for patients without symptoms or prior disease history.
Modifier GY is used for procedure codes on non-covered Medicare services where an ABN is not mandatory.
Non-participating physicians do not accept Medicare's fee schedule as full payment; they can bill up to 115% of the approved charges.

Non-participating Provider Limits

The Medicare limiting charge defines the maximum fee that non-participating providers can charge for a procedure.
Patients receive a Medicare Summary Notice (MSN) detailing services received, amounts charged, and billing amounts over a 30-day period.

Medicare Advantage and Medigap

Medicare Advantage includes three plan types: Private Fee-for-Service Plans, Coordinated Care Plans (CCP), and Medicare Savings Accounts (MSA).
Urgently needed care is categorized as unexpected illness or injury requiring immediate treatment.
Medigap plans provide supplemental insurance, filling in gaps in Medicare coverage.

Laboratory Work and Regulations

All laboratory services covered by Medicare adhere to CLIA regulations, which are managed by the Centers for Medicare & Medicaid Services (CMS).
Roster billing pertains specifically to Part B claims.

Non-physician Practitioner Services

Services provided by non-physician practitioners under physician supervision are billed using incident-to rules.

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Test your knowledge of Medicare with these flashcards focusing on key terms and definitions from Chapter 10. This quiz covers important aspects of Medicare coverage, eligibility, and enrollment processes that are essential for understanding this program.