Care CEUs

Medicare Eligibility and Entitlement

Chapter 1 - General Overview (10.2)

1. To qualify for home health benefits under either Part A or Part B of the program, a beneficiary must be confined to his/her home, under the care of a physician, and in need of skilled nursing services on an intermittent basis, physical therapy, or speech-language pathology services.

A. True B. False

Chapter 1 - General Overview (10.3)

2. Which vaccination is not covered under Part B?

A. Hepatitis B B. Hepatitis C C. Pneumococcal D. Influenza

Chapter 1 - General Overview (20)

3. The law does not permit the Federal Government to exercise supervision or control over the practice of medicine, the manner in which medical services are provided, and the administration or operation of medical facilities.

A. True B. False

Chapter 1 - General Overview (20.3.1)

4. In order to prove that fraud has been committed against the Government, it is necessary to prove that fraudulent acts were performed:

A. Knowingly B. Willfully C. Intentionally D. All of the above

Chapter 1 - General Overview (30.2)

5. The regional offices are responsible for administering the professional health aspects of the program.

A. True B. False

Chapter 1 - General Overview (60.1)

6. PROs have the authority to deny Medicare payment for medically inappropriate and unnecessary admissions.

A. True B. False

Chapter 2 - Hospital Insurance and Supplementary Medical Insurance (10)

7. Hospital insurance, as well as supplementary medical insurance, is available to the aged, the disabled, and those with which disease?

A. Lung cancer B. Cardiovascular disease C. End stage renal disease D. HIV / AIDS

Chapter 2 - Hospital Insurance and Supplementary Medical Insurance (10.4.1)

8. Entitlement usually begins after a _____-month waiting period has been served.

A. 2 B. 3 C. 4 D. 6

Chapter 2 - Hospital Insurance and Supplementary Medical Insurance (40.7)

9. The SMI premium covers about _____ of the cost of the Part B program.

A. 1/4 B. 1/2 C. 1/5 D. 1/10

Chapter 2 - Hospital Insurance and Supplementary Medical Insurance (40.7.3)

10. Premium bills are sent every 4 months unless the individual specifically requests a monthly bill or is also entitled to Premium-HI.

A. True B. False

Chapter 2 - Hospital Insurance and Supplementary Medical Insurance (50.4.1)

11. Under the RRB system, it is permissible for two beneficiaries to have identical claim numbers.

A. True B. False

Chapter 3 - Deductibles, Coinsurance Amounts, and Payment Limitations (10.2.2)

12. The patient is responsible for _____ % of the payment amount for DME furnished as a home health benefit.

A. 20 B. 30 C. 40 D. 50

Chapter 3 - Deductibles, Coinsurance Amounts, and Payment Limitations (10.4.4)

13. Which presumption(s) cannot be rebutted?

A. 6 only B. 5-7 C. 1-4 D. 1 only

Chapter 3 - Deductibles, Coinsurance Amounts, and Payment Limitations (20.5.3)

14. A unit of packed red cells is considered equivalent to:

A. A pint of plasma B. A pint of whole blood C. A quarter pint of plasma D. A quarter pint of serum albumin

Chapter 4 - Physician Certification and Recertification of Services (40)

15. If a physician refuses to certify because, in his/her opinion, the patient does not require skilled care on a continuing basis for a condition for which he/she was receiving inpatient hospital services, the services up to that point will be covered but any services beyond that date will be billed to the patient directly.

A. True B. False

Chapter 4 - Physician Certification and Recertification of Services (60)

16. Certifications and recertifications may be completed up to _____ days before the next benefit period begins.

A. 45 B. 30 C. 15 D. 5

Chapter 5 - Definitions (10.1.3)

17. If the hospital is unable to determine the deductible status, it may charge the beneficiary its full customary charges up to _____.

A. $100 B. $250 C. $500 D. $1,000

Chapter 5 - Definitions (30.3)

18. A swing bed hospital can "swing" its beds between hospital and SNF levels of care on an as needed basis.

A. True B. False

Chapter 5 - Definitions (70)

19. The term physician does not include which of the following?

A. Christian Science practitioners B. Naturopath C. Doctor of dental surgery D. (A) and (B) only

Chapter 5 - Definitions (70.6)

20. Individuals commencing their studies in a chiropractic college after June 30, 1974 must be over the age of:

A. 18 B. 21 C. 24 D. 28

Chapter 6 - Disclosure of Information (10)

21. The purpose of the Privacy Act of 1974 is to provide safeguards for individuals against an invasion of privacy by Federal agencies.

A. True B. False

22. Federal agencies are required to permit an individual to:

A. Determine what records pertaining to the individual are collected, used, or disseminated by such agencies. B. Prevent records pertaining to the individual obtained by Federal agencies for a specific purpose from being used for another purpose without the individual's consent. C. Gain access to information pertaining to the individual in Federal agency records, and to correct such records when appropriate. D. All of the above.

23. "Individual" means a living person on whom CMS has any personal information and includes sole proprietorships and partnerships.

A. True B. False

24. In order to protect the privacy of a minor, a parent or authorized guardian who requests access to the minor's medical records may not be given direct access to the records.

A. True B. False

25. The contractor must maintain accounting records for _____, or the life of the basic record, whichever is longer.

A. 1 year B. 3 years C. 5 years D. 7 years

Chapter 6 - Disclosure of Information (10.2)

26. If the contractor receives a written request for records, the contractor must determine within _____ of the receipt of the request whether it is clearly authorized to disclose the information.

A. 2 days B. 5 days C. 7 days D. 10 days

27. When able to furnish the requested materials, the contractor will furnish it whenever possible within _____ working days.

A. 5 B. 10 C. 15 D. 20

Chapter 6 - Disclosure of Information (60.1)

28. Before releasing eligibility information to providers via the telephone the intermediary or carrier must validate the provider's name and number, and obtain which of the following?

A. Beneficiary date of birth B. Beneficiary Health Insurance Claim number C. Beneficiary gender D. All of the above

Chapter 6 - Disclosure of Information (140.4.4)

29. Which of the following are cases that should be referred?

A. Over-utilization B. Overcharging C. Violation of Ethics D. All of the above

30. When a case is pending prosecution, or when a decision is pending on whether to proceed with prosecution, the contractor will delay referral to the professional society until (1) the prosecution action is completed, (2) the decision is made not to prosecute, or (3) CMS authorizes the referral.

A. True B. False

Chapter 6 - Disclosure of Information (160.1)

31. In releasing payment data, the contractor must indicate that the information refers only to the area it services and must include payments to direct dealing providers, groups practice prepayment plans, and railroad beneficiaries.

A. True B. False

Chapter 6 - Disclosure of Information (160.2)

32. The CMS regional office may authorize contractors to release which of the following information?

A. Denial rates. B. Man-hours per claim or bill processed. C. Percent of claims or total payments involving reduction in charges. D. All of the above.

Chapter 6 - Disclosure of Information (170)

33. All of the following are not subject to the rules and regulations of information in the provider's own records acquired in the administration of the Medicare program, except:

A. Name B. Marital status C. Social security number D. Address

Chapter 6 - Disclosure of Information (170.6)

34. A knowing failure to furnish the itemized statement shall be subject to a civil monetary penalty of up to _____ for each such failure.

A. $100 B. $250 C. $500 D. $1,000

Chapter 6 - Disclosure of Information (190)

35. When a Freedom of Information Act request asks for documents that include personal information, CMS must apply Exemption 6 to preclude the release of, or must otherwise redact, identifying details before disclosing the remaining information.

A. True B. False

36. The Notice of Privacy Practices for the Original Medicare Plan includes the right to:

A. File a complaint. B. Get a separate paper copy of the privacy notice. C. See and get a copy of personal health information held by Medicare. D. All of the above.

Chapter 7 - Contract Administrative Requirements (30.10)

37. Any records identified by CMS as relating to a current investigation or litigation/negotiation by the Office of the Inspector General or the Department of Justice, ongoing Workers' Compensation, set aside arrangements, or documents which prompt suspicions of fraud and abuse of overutilization of services must be kept for 2 years before being destroyed.

A. True B. False

Chapter 7 - Contract Administrative Requirements (30.10.2)

38. Which item(s) are not included in the definition of "records"?

A. Photographs B. Stocks of publications C. Magnetic tapes D. All of the above

Chapter 7 - Contract Administrative Requirements (30.30)

39. No paper Medicare records can be destroyed unless they are electronically imaged.

A. True B. False

40. A contractor who images paper Medicare records:

A. Must always be able to demonstrate the imaged version is an exact copy of the paper document. B. Document the steps taken to image the original document. C. Maintain accessibility and the ability to read the document in accordance with changes in technology. D. All of the above.

Chapter 7 - Contract Administrative Requirements (30.30.1)

41. A Witness Disposal Certification must be completed and kept on file for 10 years.

A. True B. False

Chapter 7 - Contract Administrative Requirements (30.30.1.2)

42. All paper claims that are microfilmed must be retained until CMS notifies you the freeze is lifted.

A. True B. False

Chapter 7 - Contract Administrative Requirements (30.30.2)

43. Certifications of suppliers of ambulance services are destroyed _____ from the end of the year when certification requirements are no longer met.

A. 1 year B. 3 years C. 5 years D. 7 years

Chapter 7 - Contract Administrative Requirements (40.2)

44. Which priority classification has the problem of adversely affecting the accomplishment of mission critical capability so as to degrade performance and for which an acceptable workaround is known?

A. Priority 1 Classification B. Priority 2 Classification C. Priority 3 Classification D. Priority 4 Classification

Chapter 7 - Contract Administrative Requirements (40.3.1)

45. Which of the following may initiate testing at the integration level, but are primarily dedicated to testing at the system level, including regression testing?

A. Maintainers B. Beta testers C. Maintainers and Beta testers D. None of the above

Chapter 7 - Contract Administrative Requirements (40.3.7)

46. Which of the following has the testing period begin four weeks prior to production implementation?

A. Medicare Contractor B. Shared System Beta Tester C. Shared System Maintainer D. CWF Maintainer

Chapter 7 - Contract Administrative Requirements (50.4.3)

47. The effective date identified in a change request is the date on which any new rules, laws, processes and/or policies become active.

A. True B. False

48. Effective dates are not always future dates; sometimes, they are in the past.

A. True B. False

Chapter 7 - Contract Administrative Requirements (90)

49. The IDR goal - through incremental releases - is to be the centralized data repository for all Medicare data.

A. True B. False


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