How is standard COB calculated with Medicare?
a. A sliding scale based on what the patient can afford to pay
b. As with any other COB claim
c. Based on the amount approved by the physician
d. Based on the amount approved by Medicare on an assigned claim
(
Q. 2) Which of the following is considered a guideline for the calculation of benefits under the nonduplication approach?
a. The same as with COB except that allowable expenses are those that are not listed as covered expenses under the group plan.
b. Regular individual benefits are computed applying all eligibility requirements, deductibles, limitations, and maximums.
c. If the claim is Medicare-assigned, the Medicare-approved amount is used as the base.
d. The same as with COB except that reasonable expenses are not covered expenses under the group plan.
(
Q. 3) Individual physicians are able to easily gather a large number of patients by joining the IPO, and at the same time retain their autonomy and freedom, unlike the traditional HMO doctors.
Indicate whether this statement is true or false.
(
Q. 4) The services covered under the four parts of Medicare include all of the following EXCEPT:
a. Part A is considered the basic plan or hospital insurance.
b. Part B is the medical (supplementary, voluntary) insurance.
c. Part C is the Medicare advantage portion and includes coverage exclusively for ESRD.
d. Part D is the prescription drug component (effective 2006) introduced by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
(
Q. 5) All of the following are Part C benefits EXCEPT:
a. Medicare beneficiaries may choose to have covered items and services furnished to them through a Medicare HMO which is a private insurance company that will charge a premium and copays.
b. If Medicare beneficiaries select this coverage, they are required to receive services according to the selected carrier's arrangements.
c. When patients are enrolled in a Medicare HMO, claims for these patients must be submitted to the HMO.
d. Seniors with these plans bill the remaining amounts or copays to Medicare.
(
Q. 6) Explain the history, financial responsibility, medical coverage, and benefits of TEFRA/DEFRA.
What will be an ideal response?
(
Q. 7) Physicians who treat Medicare-eligible patients who decide to accept assignment on a case-by-case basis are called nonparticipating physicians.
Indicate whether this statement is true or false.
(
Q. 8) Part A is the supplementary medical insurance, which covers physician and outpatient hospital services. It is considered a supplemental plan because each participant must pay a stipulated amount each month for the benefits.
Indicate whether this statement is true or false.
(
Q. 9) What does MFCU stand for?
a. Medicaid Fund Control Unit
b. Medicaid Fraud Control Unit
c. Medicaid Fraud Cessation Unit
d. Medicaid Fraud Control Uniformity
(
Q. 10) In an effort to provide better health coverage for Medicare beneficiaries, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 started offering Medicare beneficiary's limited coverage for prescription drug benefits.
Indicate whether this statement is true or false.
Quick Reply
