Medicare Certification Exam Questions and Correct Guaranteed with assured Answers, Exams of Nursing

Medicare Certification Exam Questions and Correct Guaranteed with assured Answers

Typology: Exams

2025/2026

Available from 07/02/2026

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Medicare Certification Exam Questions and Correct Guaranteed
with assured Answers
___________ is a national health insurance program that provides hospital
insurance, medical insurance, and a voluntary prescription drug benefit. -
Answer-Medicare
______________ are used as a classification for external causes of injury and
poisonings. - Answer-E codes
________________ assist you in using Health Insurance Portability and
Accountability Act (HIPAA) standard transactions, version 5010. - Answer-
Companion Guides
A beneficiary's red, white and blue Medicare card indicates whether
he/she has enrolled in a Medicare Advantage (MA) Plan. - Answer-False
A provider that bills Medicare Part B should contact the ________ to ask
general Medicare Secondary Payer (MSP)-related questions? - Answer-
Coordination of Benefits Contractor
Beneficiaries must be entitled to Medicare Part A, enrolled in Part B, and
live in the plan service area to be eligible to enroll in a _________ Plan -
Answer-Medicare Advantage
Condition codes, revenue codes, and occurrence codes are examples of
__________ Health Insurance Portability and Accountability Act (HIPAA)
standard code sets. - Answer-Non-medical
Denial or revocation of Medicare billing privileges, suspension of provider
payments, and application of Civil Monetary Penalties (CMPs) are all
examples of ________________. - Answer-administrative sanctions
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Medicare Certification Exam Questions and Correct Guaranteed with assured Answers ___________ is a national health insurance program that provides hospital insurance, medical insurance, and a voluntary prescription drug benefit. - Answer-Medicare ______________ are used as a classification for external causes of injury and poisonings. - Answer-E codes ________________ assist you in using Health Insurance Portability and Accountability Act (HIPAA) standard transactions, version 5010. - Answer- Companion Guides A beneficiary's red, white and blue Medicare card indicates whether he/she has enrolled in a Medicare Advantage (MA) Plan. - Answer-False A provider that bills Medicare Part B should contact the ________ to ask general Medicare Secondary Payer (MSP)-related questions? - Answer- Coordination of Benefits Contractor Beneficiaries must be entitled to Medicare Part A, enrolled in Part B, and live in the plan service area to be eligible to enroll in a _________ Plan - Answer-Medicare Advantage Condition codes, revenue codes, and occurrence codes are examples of __________ Health Insurance Portability and Accountability Act (HIPAA) standard code sets. - Answer-Non-medical Denial or revocation of Medicare billing privileges, suspension of provider payments, and application of Civil Monetary Penalties (CMPs) are all examples of ________________. - Answer-administrative sanctions

Development Questionnaires are used to determine if there are any additional ______________ for health care services. - Answer-papers to be filed Field 24E on FOrm CMS-1500 contains the most significant reason for the visit or encounter. What field is this? - Answer-diagnosis code In Volume 2: Alphabetic Index to Diseases, what is printed in bold? - Answer-Procedures In which volume would you find the hypertension table? - Answer-Volume 2 Medicare beneficiaries with End-Stage Renal Disease (ESRD) and Group Health Plan (GHP) coverage will have Medicare as the primary payer after the ____________ coordination period has elapsed. - Answer-30-month Medicare requires all providers to submit claims _______________ with limited exceptions. - Answer-electronically T/F: "Percentage of the total body with first-degree burns" is one of the four basic elements when diagnosis coding for burns. - Answer-False T/F: A beneficiary does not need to be enrolled in the Original Medicare Plan to purchase a Medigap policy. - Answer-False T/F: A physician is an example of a provider that submits claims for Part B services. - Answer-True T/F: All beneficiaries are automatically enrolled in a Medicare Prescription drug plan when they become eligible for Medicare - Answer-False T/F: An acupuncturist can enroll in Medicare. - Answer-False

T/F: Hospice care and services are excluded from Consolidated Billing for Part A residents who are in the Skilled Nursing Facility for other, non- hospice services that are in no way related to the terminal condition. - Answer-True T/F: It is a violation of the Physician Self Referral Act for a physician to refer to a Medicare beneficiary for certain Designated Health Services (DHS) to a business owned by his/her spouse. - Answer-True T/F: Medicare National Coverage Determinations (NCDs) are NOT available for review on the Centers for Medicare & Medicaid Services (CMS) website.

  • Answer-False T/F: Medicare requires a health care professional to give an Advance Beneficiary Notice (ABN) of Noncoverage to a beneficiary after a service is provided but prior to building. - Answer-False T/F: Misrepresentations of dates and descriptions for services furnished is considered fraud. - Answer-True T/F: National Coverage Determinations (NCDs) do NOT include what code, if any, is assigned to a service, or the payment amount for the service. - Answer-True T/F: People in the Original Medicare Plan can get prescription drug coverage by either joining a Medicare Prescription Drug Plan or selecting a Medigap policy that includes prescription drug coverage. - Answer-False T/F: Terms listed under certain four- and five-digit diagnosis codes are called Inclusion Terms. These terms are conditions for which a diagnosis code number is to be used. - Answer-True

T/F: The ________ between the actual charges and the Medicare covered charges is part of the formula that may be used to calculate Medicare Part B secondary payments. - Answer-difference T/F: The Department of Health & Human Services (HHS) Office of Inspector General (OIG) website does NOT include information about physician and supplier compliance programs. - Answer-False T/F: The first step of the Medicare Electronic Data Interchange (EDI) process is to review Remittance Advice (RA). - Answer-False T/F: The Health Insurance Portability and Accountability Act (HIPAA) promotes standardization and efficiency in the healthcare industry. - Answer-True T/F: The HIPAA administrative simplification provisions require employers to have standard national numbers to identify them on HIPAA standard transactions. - Answer-True T/F: The Medical Review (MR) Program identifies and addresses billing errors through the following: identifying potential billing errors concerning coverage and coding; profiling of providers, services, and/or beneficiary utilization; evaluation of complaints, enrollment, and/or cost report data; and data analysis. - Answer-True T/F: The Medicare Advantage (MA) Notice of Denial of Payment (NDP) and MA Notice of Denial of Medicare Coverage (NDMC) are used by MA Plans to notify beneficiaries upon denial, in whole or in part, of an enrollee's request for service or payment. - Answer-True T/F: The Original Medicare Plan includes Part A and Part B. - Answer-False T/F: Three punctuation symbols listed in the official ICD-9-CM guidelines are brackets, parentheses, and commas. - Answer-False

Which Health Insurance Portability and Accountability Act (HIPAA) standard transaction will you use to check the status of a claim? ASC X12N ___________ - Answer-270/ Which Health Insurance Portability and Accountability Act (HIPAA) standard transaction will you use to inquire about a beneficiary's eligibility or coverage? ASC X12N ________ - Answer-