Section 1848 (g) (4) of the Social Security Act requires that you submit claims for all your Medicare patients for services rendered. This requirement applies to all physicians and suppliers who provide covered services to Medicare beneficiaries. Providers may not charge patients for preparing or filing a Medicare claim.
| Question | Answer |
|---|---|
| Providers are required by law to file which of the following for all eligible Medicare patients? | CMS-1500 |
| If a nonparticipating provider's charge for a service is $65 and the allowed charge is $50, the amount due from the patient is | $15 |
| The most common insurance claim form is the | CMS-1500 |
Who is eligible for Medicare and how does it work?
Who is eligible for Medicare? Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). Medicare has two parts, Part A (Hospital Insurance) and Part B (Medicare Insurance).
What are the two parts of Medicare?
Medicare has two parts, Part A (Hospital Insurance) and Part B (Medicare Insurance). You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years.
Who is eligible for premium-free Medicare Part A?
You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if: You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
What resources are available for States to learn about provider management?
We have created the resources below to help states with a range of topics in provider management including enrollment, ownership and control, payments, and more. States can also use these resources to educate providers and improve compliance. Most of the resources are short fact sheets that provide high-level information on topics.
Which of the following is the Hipaa mandated electronic transaction for claims from physicians and other medical professionals?
The HIPAA-mandated electronic transaction for claims is the HIPAA X12 837 Health Care Claim or Equivalent Encounter Information, and is usually called the "837 claim" or the "HIPAA claim."
What are the options for a provider with regards to participation with Medicare?
Physicians have three ways to participate in Medicare: Sign a participation (PAR) agreement. Elect nonparticipation (nonPAR). Become a private contracting physician (opt out).
Which of the following Medicare programs covers hospital services?
Medicare Part A hospital insurance covers inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, home health care.
Which of the following Medicare programs covers hospital charges?
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
What are the options for a provider with regards to participation with Medicare quizlet?
B. Providers may participate, may choose not to participate, or may opt-out of Medicare. A Family Practitioner sees a Medicare patient and bills a 99213. This provider has opted-out of Medicare.
Which of the following services is covered by Medicare Part A or Part B quizlet?
Medicare Part A covers hospitalization, post-hospital extended care, and home health care of patients 65 years and older. Medicare Part B provides coverage for outpatient services.
What is covered by Medicare quizlet?
The program covers all those who are eligible regardless of their health status, medical conditions, or incomes. Basic health services, including hospital stays, physician visits, and prescription drugs. What are some gaps in Medicare coverage? Long-term care services, vision services, dental care, and hearing aids.
Which of the following is excluded under Medicare?
Non-medical services, including a private hospital room, hospital television and telephone, canceled or missed appointments, and copies of x-rays. Most non-emergency transportation, including ambulette services. Certain preventive services, including routine foot care.
Which of the following consumers are eligible for Medicare if other eligibility requirements are met?
Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). Medicare has two parts, Part A (Hospital Insurance) and Part B (Medicare Insurance).
Which of the following services are covered by Medicare Part B?
Medicare Part B helps cover medically-necessary services like doctors' services and tests, outpatient care, home health services, durable medical equipment, and other medical services. Part B also covers some preventive services.
What are the 4 types of Medicare?
There are four parts of Medicare: Part A, Part B, Part C, and Part D.Part A provides inpatient/hospital coverage.Part B provides outpatient/medical coverage.Part C offers an alternate way to receive your Medicare benefits (see below for more information).Part D provides prescription drug coverage.
Which of the following items is not covered by Medicare Part B?
Services that include medical and non-medical care provided to people who are unable to perform basic activities of daily living, like dressing or bathing. Long-term supports and services can be provided at home, in the community, in assisted living, or in nursing homes.