Medicare/Medicaid

Question 1

Is US insurance voluntary

Answer 1

yes

Question 2

copayment

Answer 2

dollar amount paid per service

Question 3

coinsurance

Answer 3

ratio of cost sharing

Question 4

cost sharing reduces…

Answer 4

moral hazard

Question 5

Program inclusive care for the elderly (PACE)

Answer 5

community-based care for 55 years and older who qualify for nursing home placement

Question 6

state children’s health insurance program (SCHIP)

Answer 6

covers uninsured children of families that do no qualify for traditional medicaid coverage, however make too little income to purchase traditional marketplace insurance

Question 7

department of veteran administration insurance

Answer 7

healthcare for active duty and retirees, their dependents and survivors

Question 8

Tri-care

Answer 8

a civilian health and medical program of the uniform services

Question 9

indian health service

Answer 9

comprehensive care to native americans living on reservations and in rural areas

Question 10

T or F: IHS operates its own hospitals, health centers, and health stations

Answer 10

T

Question 11

there is a “soft” cap of $______ a year for all PT settings. how do you get past it

Answer 11

2150
you check the K-X modifier box if you documentation shows more care is medically needed

Question 12

medicare is a federal ______ program while medicaid is a federal and state ______ program

Answer 12

insurance
assistance

Question 13

do pts on medicare or medicaid pay more

Answer 13

medicare

Question 14

medicare/medicaid was created in what year

Answer 14

1965

Question 15

What does MedPAC do

Answer 15

advisor committee that analyzes policies

Question 16

By 2024, medicare is expected to cover how musch of the entire pop

Answer 16

1/5
b/c of baby boomers

Question 17

medi-gap

Answer 17

selection of 10 plans that cover out of pocket expenses regarding deductibles, copays, coinsurance

Question 18

the donut hole

Answer 18

medicare part D coverage gap
have to pay you med costs if it is between 2800-4550

Question 19

medicare does not cover…

Answer 19

vision, dentures, routine foot care, routine physicals

Question 20

medicare is title ___ of social security act and medicaid is title _____

Answer 20

18
19

Question 21

charge/rate

Answer 21

set fee for a servicec

Question 22

charge

Answer 22

price set by provider

Question 23

rate

Answer 23

price set by third-party payer

Question 24

fee schedule

Answer 24

an index of charges listing individual fees for each type of service

Question 25

fee for service

Answer 25

charges are set by the provider and each service is billed separately

Question 26

what is the main drawback of fee for service

Answer 26

provider-induced demand

Question 27

bundled charges

Answer 27

a number of related services in one price

Question 28

a ______ is assigned to each CPT coded physican service

Answer 28

relative value

Question 29

relative values are based on…

Answer 29

time, skill, intensity

Question 30

CPT codes are created by who

Answer 30

american medical associationc

Question 31

case mix methods are based on

Answer 31

a comprehensive assessment
intensity of conditions

Question 32

currently, medicare is looking a lot at and performing audits on what code. why

Answer 32

therex 97110
b/c we use it a lot

Question 33

medicare spending is ______

Answer 33

increasing

Question 34

healthcare costs are ______-

Answer 34

increasing

Question 35

pay for performance

Answer 35

linking of reinbursement to quality and efficiency

Question 36

the number of people who are uninsured is ______

Answer 36

increasing
*b/c private insurance is so expensive

Question 37

what 2 groups is medicare for

Answer 37

1 - 65 and older
2 - disabled

Question 38

T or F: people with renal failure automatically get medicare

Answer 38

T

Question 39

funding for national health care programs requires______-

Answer 39

taxation

Question 40

insurance lowers _____ costs

Answer 40

out-of-pockets

Question 41

medicare pays ____% of patient’s bill

Answer 41

80

Question 42

deductible

Answer 42

amount you must pay before you begin receiving any benefits from your insruance company

Question 43

medicaid is for who

Answer 43

low income, low assets

Question 44

medicare part A

Answer 44

hospital, nursing home, home health

Question 45

medicare part B

Answer 45

outpatient pt

Question 46

medicare part c

Answer 46

supplemental insurance coverage

Question 47

medicare part D

Answer 47

prescription drug coverage

Question 48

T or F: medicaid is the lowest payer of anybody

Answer 48

T

Question 49

medicare is divided in ___ parts

Answer 49

4

Question 50

T or F: you can have medicare and medicaid

Answer 50

T: it is called dual enrollment

Question 51

with medicare you automatically get Part ____ coverage but you have to pay extra for the others

Answer 51

A

Question 52

how many complexity codes for PT evaluation

Answer 52

3 )low, moderate, high)