For a beneficiary to qualify for Medicare's skilled nursing benefit, the individual must have
had at least three inpatient days of an acute hospital stay
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15
If a service was performed on June 30, the Medicare claim must be submitted for payment and postmarked no later than
June 30 of the next year
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15
What length of time is the Medicare initial enrollment period (IEP)
7 months
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15
The entity responsible for the prevention, detection, investigation, and control of Tricare fraud, waste, and abuse is the
Program integrity office
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15
Medicare Part B will cover some home health care services if the patient
does not have Medicare Part A
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15
Medicaid reimbursement is expedited when the provider
enters an X in the Yes box in Block 27 to accept assignment
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15
One way the federal government verifies receipt of Medicaid services by a patient is by use of
a monthly survey sent to a sample of Medicaid recipients requesting verification
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15
A Medicaid card issued for the "unborn child of......" is good for
services that promote the life and health of the unborn child
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15
A Medicaid voided claim
should not have been paid originally
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trap
No points!
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magnet
Take 25 points!
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gift
Win 25 points!
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thief
Give points!
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15
An individual whose income is at or below 100 percent of the federal poverty level (FPL) and has resources at or below twice the standard allowed under the SSI program may receive assistance from Medicaid to pay for Medicare premiums, deduc
and coinsurance amounts as a qualified Medicare beneficiary (QDWI)
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15
Medicare Part A coverage is available to individuals under the age of 65 who
have end-stage renal disease and meet requirements
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baam
Lose 10 points!
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rocket
Go to first place!
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shark
Other team loses 25 points!
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banana
Go to last place!
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lifesaver
Give 25 points!
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fairy
Take points!
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25
fairy
Take points!
5
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25
thief
Give points!
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10
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20
25
15
Individuals who are eligible for both Medicare and Medicaid coverage are called
dual eligibles
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15
A critical pathway is the
sequence of activities that can normally be expected to result in the most cost-effective clinical course of treatment