Chris Camarillo

Mrs. Graves
Level II AM Class
29 March 2017
Billing Worksheet Chapter 1
1. What two groups of persons were added to those eligible for Medicare benefits after the
initial establishment of the Medicare program?
a. People with disabilities
b. People with renal diseases
2. To what government organization did the secretary of the Department of Health and
Human Services delegate the responsibility for administering the Medicare program?
a. Centers for Medicare and Medicaid Services (CMS)
3. What government organization handles the funds for the Medicare program?
a. The Social Security Administration
4. There are three items that Medicare beneficiaries are responsible for paying before
Medicare will begin to pay for services. What are these three items?
a. Deductibles
b. Premiums
c. Coinsurance
5. Medicare publishes the Medicare fee schedule and usually pays what percentage of the
amount indicated for services?
a. 80 percent
6. The three components or work, overhead (practice expense), and malpractice are part of
an RVU. What do the intials RVU stand for?
a. Relative Value Unit
7. According to the filing guidelines, providers must file claims for their Medicare patientts
within 12 months of service.
8. What editions of the Federal Register would the outpatient facilities be interested in?
a. November and December
9. Under what act was a major change in Medicare in 1989 made possible?
a. Omnibus Budget Reconciliation Act of 1989 (OBRA)
10. Can a physician charge a patient to complete a Medicare form?
a. No
11. Individuals covered under Medicare are termed beneficiaries.
12. The Medicare Administrative Contractors do the paperwork for Medicare and are usually
insurance companies that have a bid for a contract with CMS to handle the Medicare
program for a specific area.
13. Medicare Part C is also known as Medicare Advantage Organizations.
14. HIPAA stands for Health Insurance Portability and Accountability Act.
15. The most major change to the healthcare industry as a result of HIPAA was as a result of
what portion of the act?
a. Administrative Simplification
16. The transfer of electronic documentation is accomplished through the use of electronic
data interchange technology.
17. The number that is assigned to all providers as a result of HIPAA:
a. National Provider Identification
18. Under the Relative Unit system, unit values are assigned to each service and are
determined on the basis of the resources necessary to the physician's performance of the
service.
19. The limiting charge historically was specific for each physician, but in 1933, the charge
for a service was the same for all physicians within a locality, regardless of the specialty.
20. For co-surgeons, Medicare pays the lesser of the actual charge or 125 percent of the
global fee, dividing the payment equally between two surgeons.
21. Specific regulations for Medicare are contained in the Internet Only Manual.
22. Within an HMO, there is usually an individual who has been assigned to monitor the
services provided to the patient both inside the facility and outside the facility. This
person is known as the Gatekeeper.
23. In this model of HMO, the HMO directly employs the physician
a. Group Practice Model
24. In this model of HMO, the HMO contracts with the physician to provide the service at a
set fee. These organizations are known as Individual Practice Associations.
25. An all-inclusive care program for the elderly that provides a comprehensive package of
services that permits the client to continue to live at home is known as Program for All-
Inclusive Care for the Elderly (PACE).