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Medicare review

CDT Current Dental Terminology
CPT Level 1 HCPCS Codes
HCPCS Healthcare Common Procedure Coding System
HCPCS Level 2 codes (also known as national)
HCPCS Codes are organinzed by type of service
Injection require 1 CPT (for the act of injecting) and 1 HCPCS code (for medicine)
Modifiers Two digit code attached to procedure ti indicate alteration to procedure
Tabular index Coding index in which procedures are listed in Numerical Order
Temporary Codes may remain temporary forever
Ambulance Service are only paid if no other transportation was available
Ambulatory Surgical Center is a separate business entity, but may be located in hospital
Ambulatory Surgical Center fee schedules are decided by Geographical Wage Index
Balance Billing when provider attempts to bill patient what Medicare does not allow. (illegal)
Case Mix the different types of patients within a health care facility
DRG patient in groups according to diagnosis
DSM only used by physician to describe mental
IPPS Inpatient prospective payment system
IRVEN software used for rehabilitation system
MPFS formerly RBRVS, what Medicare allows for procedures
DSM Diagnostic and Statisticl Manual
DRG Diagnosis Related Group
MPFS Medicare Physician Fee Schedule
Nonphysician Providers must accept assignment
OASIS used for patients receiving Home Health Care medical Service
Per diem Latin for each day
RAVEN software used for skilled nursing facilities
ABN Advanced Beneficiary Notice
ABN obtained before a procedure that Medicare is likely not cover.
Benefit Period begins with fist day of hospitalization and ends when patient has been out for 60 consecutive days after discharge
coinsurance must be collected by provider and failure to do so is punishable by fines
deadline for filing a claim with Medicare one year from date of service
General Enrollment Period held every year from jan 1st to march 31st
Hospice program for both inpatient and outpatient care of teminally ill individuals
Initial Enrollment Period first seven months after applying or turning 65
Limiting Charge Maximum amount that Nonpar may charge medicare enrollee
medicare secondary payer (msp) info must be obtained first time patient is seen
Medicare fee Schedule is developed by Medicare Administrative Contractors(MACS)
Medicare Select type of Medigap that requires enrollees to use network of providers
Medicare Summary Notice monthly statement that clearly lists health insurance info
Medigap supplemental Medicare caoverage
NonPARs may accept assingment on a claim by claim basis
Nurse Practitioner must work with a physician
private contract doctor opted out of medicare for two years cannot charge medicare but charge patient whatever they want
respite care service offered to provide relief to non-paid family members who take care of terminally ill patient
roster billing mass vaccinations, NO donations may be collected
part a covers inpatient hospitalization, hospice care, home health facilities, skilled nursing facilities
part d prescription drugs
special enrollment period must prove you were unable to meet the first two time periods
Created by: quece79