Medicare beneficiaries - Study guides, Class notes & Summaries

Edward IP suffered from serious kidney disease. As a result. Edward became eligible for Medicare coverage due to end-stage renal disease (ESRD). A close relative donated their kidney and Edward successfully underwent transplant surgery 12 months ago. Edward is now age 50 and asks you if his Medicare coverage will continue, what should you say? Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months after the month in which the individual receives a kidney trans...

Your license will be considered to be inactive when you: - correct answer No longer have any appointments On a "participating" health insurance policy issued by a mutual insurance company, dividends paid to policy holders are: - correct answer Not taxable since the IRS treats them as a refund of a portion of the premium paid All of the following are true regarding a non-contributory employer group medical expense insurance policy EXCEPT: - correct answer Premiums must be paid entirely...

Certified Specialist Payment Rep (CSPR) HFMA 2024/25 Review-Steps used to control costs of managed care include: - Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify - Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred Identify the various types of private health plan coverage - HMO Conventional PPO and POS HDHP/SO plans - high...

Mr. Shapiro gets by on a very small amount of fixed income. He has heard there may be extra help paying for Part D prescription drugs for Medicare beneficiaries with limited income. He wants to know whether he might qualify. What should you tell him? Question 1Select one: a. The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government.

What is the maximum amount of time an insurer has to provide the claimant the forms for filing proof of loss? 1. 7 days 2. 15 days 3. 30 days 4. 90 days - Answer- 2. 15 days Which of the following is the most common method to supplement Medicare coverage? 1. Medicaid 2. Group health insurance 3. Employer Health Insurance 4. Coverage offered by private insurers - Answer- 4. Coverage offered by private insurers In which of the following must a beneficiary change request be filed in w...

ICD-10-CM Questions and Answers Already Passed What edition of the Federal Register would hospital facilities be especially interested in? A. July B. November or December C. October D. January C. October What edition of the Federal Register would outpatient facilities be especially interested in? A. November or December B. October C. January D. July A. November or December What is the largest third-party payer? A. American government B. Department of Health and Human ...

Medical Coding Training: CPC exam {124 QUESTIONS AND ANSWERS} Which statement below describes a medically necessary service? A. Performing a procedure/service based on cost to eliminate wasteful services. B. Using the least radical service/procedure that allows for effective treatment of the patient's complaint or condition. C. Using the closest facility to perform a service or procedure. D. Using the appropriate course of treatment to fit within the patient's lifestyle. - CORREC...

CPCO MOCK EXAM 2024/ LATEST UPDATE EXM WITH CORRECT VERIFIED ANSWERS/ GRADED A+ A History of Healthcare Compliance in the U.S. Question 1 Dr. X hires a nurse without looking to see if she was on the OIG’s Exclusion List. The nurse was previously convicted of committing fraud and was excluded. Dr. X receives payments from Medicare for services rendered to Medicare beneficiaries. Is it ok for Dr. X to have this nurse on staff? Yes, as long as the nurse pays a CMP. No, Dr. X ...

Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully treated for that condition. However, she and her physicians feel that after her lengthy hospital stay, she will need a month or two of nursing and rehabilitative care. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? - Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20 days of her stay, after which she would...

Abuse - Actions inconsistent with accepted, sound medical business or fiscal practice Accept Assignment - Provider accepts as payment in full whatever is paid on the cliam by the payer (except for any copayment and or coinsurance amounts.) Accounts Receivable - The amount owed to a business for services or goods provided. Accounts Receivable Aging Report - Shows the status (by date) of outstanding claims from each payer, as well as payments due from patients. Accounts Receivable Management -...