Exam I

Question 1

Premium

Answer 1

buying the insurance

=>policy holder pays this

Question 2

Co-pay

Answer 2

fixed amount the patient pays for a covered health care service

Question 3

Co-insurance

Answer 3

paid by the patient once the deductible is met

Question 4

Assignment

Answer 4

what Medicare or other insurer will pay for services

Question 5

Explanation of benefits

Answer 5

form sent to provider (patient) stating what has been paid by insurance and what the patient owes

Question 6

ABN

Answer 6

form patient signs when the DC knows Medicare will not pay for a service

Question 7

CMS

Answer 7

Center for Medicare and Medicaid services; who administers Medicare

Question 8

OIG

Answer 8

Office of Inspector Generals

Question 9

NPI

Answer 9

National Provider Identifier

=>needed to enroll in Medicare

Question 10

Medical Necessity services

Answer 10

• have been established as safe and effective
• are consistent w/ sx or dx
• are necessary and consistent with generally accepted medical practices
• are furnished at the most appropriate, safe and effective level

Question 11

Active care

Answer 11

provides reasonable expectation of recovery or improvement of function
=>can be acute or chronic

Question 12

AT

Answer 12

acute, active, restorative, arrest of progression or corrective care
=>code will be reimbursed

Question 13

GA

Answer 13

maintenance care, ABN signed, pt knows Medicare won’t pay

Question 14

GZ

Answer 14

DC forgot to present the ABN

Question 15

GY

Answer 15

statutorily excluded service

=>x-ray, new pt exam

Question 16

GX

Answer 16

statutorily excluded service, ABN voluntarily signed

Question 17

GP

Answer 17

for non-CMT physical therapies performed only by physical therapist