Section 13 - Health Providers Flashcards
Part A hospital expense coverage provided under Medicare is automatically made available to each of the following EXCEPT
A. A 50 year old individual who is qualified and SSDI in the last 24 months
B. A 70 year old NOT eligible for Social Security
C. A 55-year-old suffering from kidney failure
D. A 65 year old retiree
A 70 year old NOT eligible for Social Security
Small employers who are sponsored by an insurer to provide group benefits to its employees are called
A. Fraternal benefit society
B. Surplus lines brokers
C. Lloyds of London
D. MEWA
MEWA
A Doctor who excepts Medicare assignment agrees to which of the following?
A. Doctor may charge up to a maximum of 15% more than Medicare pays for the service
B. Doctor is not bound by Medicare as limitations on charges.
C. Doctor cannot charge more than Medicare‘s scheduled coverage
D. Doctor bills the Medicare beneficiary directly for services performed
Doctors cannot charge more than Medicare’s scheduled coverage
What is Medicare part B also known as?
A. Medicare supplement
B. Supplementary medical insurance
C. Comprehensive insurance
D. Medicaid
Supplementary medical insurance
Maria is a Preferred Provider Organization subscriber and received care from an out-of-network provider. Which of the following is the likely result?
A. Care is covered
B. Care is not covered
C. Care is only covered in the government facility
D. Care is only covered if primary care physician gives a referral
Care is covered
Medicare part B covers
A. Long-term care
B. Hospital room and board
C. Doctor’s charges
D Prescription drugs
Doctor’s charges
How is Medicare part B funded?
A. Employer taxes
B. Payroll taxes
C. User premiums
D. General tax revenue and user premiums
General tax revenue and user premiums
A closed network plan offers a primary physician co-pay of $25. If a subscriber chooses a primary care physician outside of the network the subscriber will likely pay
A. $0
B. $25
C. 100% of the billed amount
D. 100% of the allowed amount
100% of the billed amount
A medical provider that accepts Medicare assignment must
A. Accept payment based upon a defined Medicare schedule and build the insured for any difference
B. Accept payment based upon a defined Medicare schedule and negotiate any excess fees
C. Accept payment based upon a defined Medicare schedule and Bill no more than 15% of the access charges
D. Accept payment based upon a defined Medicare schedule as payment in full
Accept payment based upon a defined Medicare schedule as payment in full
A healthcare provider claim it may be settled using which of the following payment methods?
A. Litigation
B. Unfair claims settlement
C. Fee-for-service
D. Prepaid expense
Fee for service
An accident and health policy that provides reimbursement benefits makes them payable to the
A. Provider
B. Facility providing service
C. Insured
D. Insured’s spouse
Insured
An HMO that involves a partnership of physicians and other providers who practice out of a central facility is called a(n)
A. Group HMO
B. Federal HMO
C. Central HMO
D. Managed HMO
Group HMO
Funding for Medicare part B is partially provided by
A. Municipal bonds
B. State finds
C. Private insurers
D. User Premiums
User premiums
How much does Medicare part B pay for physician fees?
A. 40%
B. 60%
C. 80%
D. 100%
80%
Which of these is not a qualifying event for Medicare?
A. On Social Security disability for over two years
B. Kidney failure
C. Age of 65 or older
D. Falling below the federal poverty level
Falling below the federal poverty level
