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I & R Issue chap 5

Legal newspaper published every business day by the national archives and records administration Federal Register
Contain new and changed Medicare policies and/or procedures that are to be incorporated into a specific CMS program Program transmittals
An organization that contracts with CMS to process fee for service health care claims and perform program integrity tasks for both Medicare part A and Part B Medicare administrative contracter
The assignment of ICD-9-CM diagnosis codes that does not match patient record documentation for the purpose of illegally increasing reimbursement Upcoding
The storage of documentation for an established period of time. record retention
An intentional description of misrepresentation that someone makes knowing it it is false that could result in an unauthorized payment. Fraud
Involves actions that are inconsistent with accepted sound medicall business or fiscal practice. Abuse
2 examples of fraud 1.Misrepresent the diagnosis to justify payment 2.Unbundling Codes
2 examples of Abuse 1. excessive charges for services2. violation of PAR agreements with insurance companies
Pairs of HCPCS and/or CPT Codes CCI Edits
major procedure of service code Column 1 Code
lesser procedure code Column 2 code
Procedures or services that could not reasonably performed at the same session Mutually exclusive codes
Reporting bundling procedure codes in addition to the major procedure code is characterized as _____________. Unbundling
The practice of Unbundline Occurs because Provider's coding staff unintenionally reports multiple codes based on misinterpreted coding guidelines-reporting of multiple codes is intentional and is done to maximize reimbursement
Assigned to third party payers national health planID
put on hold by congress national individual identifier
Assigned to healthcare rpoviders national provider identifier
Assigned to employers national standard employer identification number (EIN)
Created by: tlindrose