Domain IV

Front

Which one of the following types of care is not covered by Medicare Part A? Long-term nursing care, Skilled nursing care, Hospice care, Outpatient services

Back

Outpatient services

Answer explanation

Medicare Part A covers inpatient care, including skilled nursing and hospice care, but does not cover outpatient services, which are typically covered under Medicare Part B.

Front

_____ covers prescribed preventive benefits and is subject to an annual deductible.

Back

Medicare Part B

Answer explanation

Medicare Part B covers prescribed preventive benefits and requires beneficiaries to meet an annual deductible before coverage begins, distinguishing it from Medicare Part A and Medicaid.

Front

The amount charged for a medical insurance policy is called the _____.

Back

Premium

Answer explanation

The amount charged for a medical insurance policy is called the 'Premium'. This is the regular payment made to maintain coverage, distinguishing it from terms like 'deductible' or 'co-payment', which refer to out-of-pocket costs.

Front

Some services are covered and paid under Medicare before payments are made by Medicaid because Medicaid is considered the _____?

Back

Payer of last resort

Answer explanation

Medicaid is known as the 'payer of last resort' because it only pays for services after all other potential sources of payment, like Medicare, have been exhausted.

Front

A _____ occurs when radiological and other procedures that include professional and technical components are paid as a lump sum to be divided between the physician and the healthcare facility.

Back

Global payment

Answer explanation

A global payment is a single payment that covers both the professional and technical components of radiological procedures, making it the correct choice for the definition provided.

Front

Which of the following is a fee-for-service payment? Options: Global payment, Ambulatory surgery, Professional surgery, Technical surgery

Back

Global payment

Answer explanation

Global payment is a fee-for-service model where providers are paid for each service rendered, unlike bundled payments which cover multiple services under a single fee. Therefore, it is the correct choice.

Front

A(n) _____ center is a state-licensed, Medicare-certified supplier of outpatient surgical services to Medicare beneficiaries.

Back

Ambulatory surgery

Answer explanation

An ambulatory surgery center is specifically designed to provide outpatient surgical services and is licensed and certified to serve Medicare beneficiaries, making it the correct choice for the blank.

Front

Which program covers healthcare costs and lost income associated with work-related injuries and illnesses? Options: Indian Health Service, CHAMPVA, State Children’s Health Insurance Program

Back

Workers’ compensation

Answer explanation

Workers’ compensation is the program specifically designed to cover healthcare costs and lost income due to work-related injuries and illnesses, making it the correct choice.

Front

Which classification system was established for the prospective reimbursement of covered home care services to Medicare beneficiaries during a 60-day episode of care? Options: OASIS, HAVEN, HHRGs, RUGs

Back

HHRGs

Answer explanation

The Home Health Resource Groups (HHRGs) classification system was established to determine reimbursement for home care services provided to Medicare beneficiaries during a 60-day episode of care.

Front

Which of the following does not describe capitation? Provides all contracted healthcare services needed by an individual, Individual enrollee or third-party payer pays a fixed premium for the covered group, Payment for each medical service is usually based on the actual charges of the provider, Contract stipulates exactly which healthcare services are covered and which ones are not

Back

Payment for each medical service is usually based on the actual charges of the provider

Answer explanation

Capitation involves a fixed payment for a range of services, not based on actual charges for each service. Thus, the statement about payment based on actual charges does not describe capitation.