M11:

Question 1

The year Medicare was implemented

Answer 1

1966

Question 2

The age of most individuals covered by Medicare

Answer 2

Age 65 or older

Question 3

Hospital Insurance (HI)

Answer 3

Medicare Part A

Question 4

Supplementary Medical Insurance (SMI)

Answer 4

Medicare Part B

Question 5

Number of skilled nursing facility days under Medicare

Answer 5

Limited to 100 days per benefit period

Question 6

% individuals must pay under Medicare for durable med. equipment

Answer 6

20% coinsurance

Question 7

Begins with hospital entry, ends with a break of 60 days

Answer 7

Benefit Period Concept in Medicare Part A

Question 8

Medicare Advantage Program, which expands options for participation in private-sector health plans

Answer 8

Medicare Part C

Question 9

A type of Medicare Advantage plan. They’re not required to have networks of participation providers

Answer 9

Private fee-for service (PFFS) plans

Question 10

Prescription drug insurance coverage

Answer 10

Medicare Part D

Question 11

Coverage of long-term nursing care

Answer 11

Something not covered by Medicare

Question 12

How the HI trust fund is financed

Answer 12

Primarily through mandatory payroll tax

Question 13

Part A tax rate

Answer 13

1.45% of earnings paid by employees and employers

Question 14

SMI is composed of 2 parts

Answer 14

Part B and Part D

Question 15

Private health insurance that pays charges not covered by Parts A or B

Answer 15

Medigap

Question 16

Number of lifetime reserve days for each beneficiary covered under Part A

Answer 16

60 additional hospital days

Question 17

Medicare payments for most inpatient hospital services are made under this reimbursement mechanism

Answer 17

Prospective Payment System (PPS)

Question 18

The Medicare rate is accepted as payment in full for a service provided

Answer 18

Doctor accepts assignment

Question 19

Entities that process fee-for-service claims for both Part A & B services to providers/supplies in geographic jurisdiction

Answer 19

Medicare administrative contractors (MACs)

Question 20

The part of Medicare with the greatest cost variation of any type

Answer 20

Part D plans

Question 21

A comprehensive listing of maximum fees used to pay providers

Answer 21

Fee Schedule

Question 22

Defined as the lowest of 1) the physician’s actual charge, 2) the physician’s customary charge, 3) the prevailing charge for similar services in the locality.

Answer 22

Reasonable Charges (used to pay Part B physicians prior to 1992)

Question 23

Defined as the lesser of 1) the submitted charges, 2) the amount determined by a fee schedule based on a relative value scale.

Answer 23

Allowed Charges (used to pay Part B physician costs post 1992)

Question 24

Defined as a fixed, predetermined amount per month per member is paid to the plan, without regard to the actual number and nature of services used by the members

Answer 24

Capitation - how Medicare Advantage pays

Question 25

Processes and pays fee for service claims for both part A and Part B services to all providers and suppliers within its geographic jurisdiction

Answer 25

Medicare Administrative Contractors (MAC)

Question 26

Groups of practicing healthcare professionals who are paid by the federal government to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries

Answer 26

Quality Improvement Organizations