Part 3 Flashcards
TRUE/FALSE: The patient and the guarantor are always the same person.
FALSE
Which person is responsible for paying the charges?
A. Payer
B. Guarantor
C. Enrollee
D. Patient
Guarantor
Which is the special group that requires states to pay Medicare Part A premiums for certain disabled individuals who lose Medicare coverage because of work?
A. Qualified Medicare beneficiaries
B. Qualifying individual
C. Qualified working disabled individuals
D. Specified low income Medicare beneficiaries
Qualified working disabled individuals
A regulatory requirement for all governmental programs that signifies that the patient accepts financial responsibility regardless of insurance processes and releases his clinical information for the purposes of payment
A. Waiver
B. Medical Necessity
C. Chargemaster
D. Advanced beneficiary notice
Advanced beneficiary notice
Which is the special group that requires states to pay Medicare Part B premiums for individuals with incomes between 100 and 120 percent of the federal poverty level?
A. Qualified Medicare Beneficiaries
B. Specified low income Medicare beneficiaries
C. Qualifying individuals
D. Qualified working disabled individuals
Specified low income Medicare beneficiaries
Which describes annual income guidelines established by the federal government?
A. Temporary assistance for needy families
B. Federal Poverty level
C. Supplemental security income
D. Medically needy Medicaid program
Federal Poverty level
The difference between a rejected claim and a denied claim is that
A. If a procedure or service is unauthorized, the claim will be rejected, not denied
B. A denied claim is sent back to the provider, errors may be corrected and the claim resubmitted
C. A rejected claim may be appealed but a denied claim may not be appealed
D. A rejected claim is sent back to the provider, errors may be corrected and the claim resubmitted
A rejected claim is sent back to the provider, errors may be corrected and the claim resubmitted
Temporary disability claims cover health care treatment for illness and injuries as well as payment for __________.
A. Employer Benefit
B. Lost wages
C. Pain and suffering
D. Medical services
Lost wages
Which is the Tricare managed care option similar to a civilian health maintenance organization?
A. Tricare Standard
B. Tricare Prime
C. Tricare Extra
D. Tricare
Tricare Prime
Which of the following is true about Medicare Part B Insurance?
A. It is a voluntary supplementary insurance
B. It covers all acute care hospitalization costs
C. It covers all skilled nursing care costs
D. It is automatically provided to every senior citizen over the age of 65 or older
It is a voluntary supplementary insurance
