Health Care Reimbursement Worksheets
Week 4 Assignment How will I apply what I know about Medicare, Medicaid, and Tricare insurances on the job? This assignment helps you apply your knowledge from this week’s modules and readings. As a medical billing specialist, you will be expected to submit claims to Medicare, Medicaid, and Tricare insurance plans for reimbursement of services. Recognizing the differences between these insurance plans, and the rules that apply for billing each of them, is necessary to ensure the practice receives maximum payment. 50 Medicare Refer to Chapter 14 of your textbook to answer the following questions. 1. Relating to Introduction CMS is responsible for administering the ___________ program. ☐ Healthcare Management ☐ Medicare ☐ TRICARE ☐ Workers’ compensation 2. Relating to Introduction Medicare Part ___________ reimburses institutional providers for inpatient, hospice, and some home health services. ☐A ☐B ☐C ☐D 3. Relating to Medicare Part A Hospitalizations A Medicare benefit period is defined as beginning the first day of hospitalization and ending when ___________. ☐ the patient has been admitted to a skilled nursing facility. ☐ the patient has been officially discharged from the hospital. ☐ the patient has been out of the hospital for 60 consecutive days. ☐ the spell of illness has ended for the patient. © Ultimate Medical Academy. 1 4. Relating to Medicare Part A Hospitalizations List the 3 types of facilities and 2 types of special care services covered by Medicare Part A. Types of facilities Types of special care services a. Type answer here d. Type answer here b. Type answer here e. Type answer here c. Type answer here 5. Relating to Medicare Part C List the 5 types of Medicare Advantage Plans (Medicare Part C) enrollees can choose from. a. b. c. d. e. Type answer here Type answer here Type answer here Type answer here Type answer here Medicaid Refer to Chapter 15 from you textbook to answer the following questions. 6. Related to Categorically Needy Groups Which of the following is a requirement used to determine Medicaid eligibility for mandatory categorically needy eligibility for families? ☐ AFDC ☐ EPSDT ☐ PACE ☐ TANF 7. Related to Services of Categorically Needy Eligibility Groups Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services are available to ___________. ☐ all children enrolled in Medicaid ☐ qualified individuals over age 65 ☐ individuals who are dual eligible ☐ children under the age of 12 © Ultimate Medical Academy. 2 8. Related to Medicaid as a Secondary Payer When a patient has Medicaid coverage in addition to other, third-party payer coverage, Medicaid is always considered the ___________. ☐ adjusted claim. ☐ medically necessary service. ☐ payer of last resort. ☐ remittance advice. 9. Related to Medicaid Remittance Advice Which does Medicaid use to communicate information about claims processing and reimbursement to the provider? ☐ remittance advice ☐ explanation of benefits ☐ claims adjudication ☐ assignment of benefits 10. Related to Accept Assignment ___________ must be selected on the CMS-1500 claim or reimbursement from Medicaid may be denied. ☐ patient next of kin ☐ accept assignment ☐ number of dependents ☐ transportation services © Ultimate Medical Academy. 3 ME2540: Week 5 Assignment How do I summarize all aspects of disability insurance and benefit programs? This assignment helps you to summarize and review information in the workplace. Healthcare employers expect medical office professionals to be familiar with state disability insurance programs. 50 Commercial Insurance Refer to Chapter 12 of your textbook to answer the following questions. 1. Relating to Commercial Claims When a patient is covered by a large employer group health plan (EGHP) and Medicare, which is primary? ☐ EGHP ☐ Medicare ☐ no distinction is made between the plans ☐ the plan that has been in place longest 2. Relating to Commercial Claims When a child who is covered by two or more plans lives with his married parents, the primary policyholder is the parent ___________. ☐ who is older. ☐ who is younger. ☐ whose birthday occurs first in the year. ☐ whose birthday occurs later in the year. Tricare and Veterans Healthcare Refer to Chapter 16 from you textbook to answer the following questions. 3. Relating to Tricare Who manages each TRICARE region and is responsible for the military health system in that region? ☐ lead agent © Ultimate Medical Academy. 1 ☐ primary care manager ☐ beneficiary services provider ☐ health care finder 4. Relating to Tricare Service Centers Where can TRICARE sponsors find beneficiary services representatives and health care ﬁnders for assistance with health care needs and answers to questions about the program? ☐ TRICARE Service Centers ☐ Program Integrity Office ☐ Military Health Services System ☐ TRICARE Management Activity 5. Relating to Program Integrity Office Which is responsible for surveillance of TRICARE fraud and abuse activities? ☐ Program Integrity Office ☐ Surveillance and Utilization Review System (SURS) ☐ TRICARE Management Activity Office ☐ Office of Inspector General (OIG) 6. Related to Tricare and Tricare Options Match Tricare and Tricare for Life items to the correct description. A. Tricare Extra B. Tricare Standard D. Certain former spouses C. Medicare eligible-uniformed service retirees E. Tricare Prime ___. Includes retired National Guard and Reservists. ___. This option is a Preferred Provider Organization (PPO). ___. Must have been eligible for TRICARE before age 65. ___. This option is fee-for-service and was previously known as CHAMPUS. ___. Widows and widowers. © Ultimate Medical Academy. 2 Workers’ Compensation Refer to Chapter 17 from you textbook to answer the following questions. 7. Related to Workers’ Compensation Match the workers’ compensation terms to the correct description. A. First Report of Injury Form B. Disability Medical documentation C. Filing Time Limit & Compensation Payer D. Appeals E. Adjudication ___. Process of obtaining judicial dispute resolution process involving a final determination for reimbursement made by Appeals Board. ___. Narrative progress/supplemental reports ___. Denied reimbursement can be reconsidered through request made to appropriate Compensation Board. ___. Payer is determined based on timely filing of First Report of Injury form verification of injury, and filed within 24 hours to 14 calendar days, based on state requirements. ___. Documentation of disability injury, date & time of onset of disease, site, description, etc. 8. Relating to Federal Workers’’ Compensation Programs Which program was created to protect employees against injuries from occupational hazards in the workplace? ☐ OSHA ☐ MSHA ☐ FECA ☐ EEOIC 9. Related to Special Handling of Workers’ Compensation Cases For work-related injuries that occur in a state other than where the employee works, contact the workers’ compensation board ___________. ☐ in the state where the injury occurs ☐ in the state where the employer’s headquarters is located ☐ at the state where the employee receives treatment ☐ in the state where the employee resides © Ultimate Medical Academy. 3 10. Relating to Workers’ Compensation and Managed Care Which is the special report that is completed and submitted to the workers’ compensation payer when the patient first seeks treatment for a work-related injury? ☐ First Report of Injury form ☐ authorization for release of medical information ☐ CMS-1500 claim ☐ progress note © Ultimate Medical Academy. 4 …
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