Midterm Review

Question 1

charging for a higher procedure than what was provided

Answer 1

upcoding

Question 2

is upcoding ethical?

Answer 2

NEVER

Question 3

what is a third-party payer?

Answer 3

insurance company

Question 4

largest third-party payer

Answer 4

government through Medicare

Question 5

Part A

Answer 5

hospital insurance

Question 6

Part B

Answer 6

Supplemental medical insurance

Question 7

who is responsible for the administration of the Federal Medical program

Answer 7

DHHS (Secretary of the Department of Health and Human Services)

Question 8

who is responsible for collecting and handling the funds

Answer 8

Social Security Administration

Question 9

handles the daily operations of Medicare

Answer 9

CMS

Question 10

insurance companies that bid for a contract with CMS

Answer 10

MACs

Question 11

physicians, hospitals, and other suppliers that furnish care or supplies to Medicare patients

Answer 11

providers

Question 12

Medicare pays for ___% of allowable charges

Answer 12

80

Question 13

20% that Medicare does not pay

Answer 13

coinsurance

Question 14

Beneficiary pays…

Answer 14

1. deductible
2. premiums
3. coinsurance (20%)
4. 100% of noncovered services

Question 15

Medicare pays…

Answer 15

Covered services (80%)

Question 16

amount of money an individual or business pays for an insurance policy

Answer 16

premium