Midterm Part 4 Flashcards
Medicare benefit period begins with the first day of hospitalization and ends when the patient has been out of the hospital for ______ consecutive days.
A. 10
B. 90
C. 60
D. 30
60
Which program added prescription medication coverage to the original Medicare plan, some Medicare cost plans, some Medicare private fee-for-service plans, and Medicare medical savings account plans?
A. Medicare Part D
B. Medicare Part B
C. Medicare Part A
D. Medicare Part C
Medicare Part D
Which insurance claim is submitted to receive reimbursements under Medicare part B?
A. CMS-1500
B. UB-92
C. UB-04
D. CMS-1450
CMS-1500
Which is the amount for which the patient is financially responsible before an insurance policy provides payment?
A. Coinsurance
B. Exclusionary
C. Deductible
D. Copayment
Deductible
A managed care network of physicians has hospitals that have joined together to contract insurance companies, employers, or other organizations to provide health care to subscribers for a discounted fee is called a(n) ______.
A. Independent practice association
B. Preferred provider organization
C. Triple option plan
D. Point-of-service plan
Preferred provider organization
The health plan reimburses Dr. Tan $15 per patient per month. In January, Dr. Tan saw 300 patients so he received $4,500 form the health plan. Which method is the health plan using to reimburse Dr. Tan?
A. Traditional Retrospective
B. Capitation Rate
C. Discounted Fee Schedule
D. Relative Rate
Capitation Rate
A healthcare maintenance organization (HMO) is an alternative to traditional group health insurance coverage and provides comprehensive health care services to voluntarily enrolled members on a ______ basis.
A. Fee-for-service
B. Per Diem
C. Retrospective
D. Prepaid
Prepaid
What part of the Medicare program was created under the Medicare Modernization Act of 2003?
A. Part B
B. Part C
C. Part A
D. Part D
Part D
Accountable care organizations ___________.
A. Amended the PPACA to implement health care reform initiatives, closing the Medicare “donut hole”
B. Help physicians, hospitals, and other health care providers work together to improve care for people with Medicare
C. Focus on private health insurance reform to provide better coverage for individuals with pre-existing conditions
D. Authorized an expenditure of $1.5 billion for grants for construction, renovation, and equipment, and for the acquisition of health information technology systems
Help physicians, hospitals, and other health care providers work together to improve care for people with Medicare
Medicare requires providers to submit the _______ claim for payment of outpatient and office services.
A. CMS-1450
B. CMS-1500
C. UB-02
D. UB-04
CMS-1500
