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2013 Chpt1 MAOA

Reimbursement HIPAA & Compliance

QuestionAnswer
What two groups of persons were added to those eligible for Medicare benefits after the initial establishment of the Medicare program? Persons over age 65 and Patients experiencing end stage renal failure
To what government organization did the Secry of the dept of Health & Human Serviced delegate the responsibility for administering the Medicare program? CMS = Centers for Medicare & Medicaid
What government organization handles the funds for the Medicare program? The Social Security Administration
There are three items that Medicare beneficiaries are responsible for paying before Medicare will begin to pay for services. What are these three items? 1) Deductibles 2) Premiums 3) Coinsurance Payments
Medicare publishes the Medicare Fee Schedule and usually pays what percentage of the amounts indicated for services? 80% Medicare will pay for
The three components of work, overhead (practise expertise) and malpractice are part of an RVU. What to the initials stand for? RVU stands for Relative Value Unit
According to the filing guidelines, providers must file claims for their Medicare patients with ___ months of the date of service. 12 months is the time frame that Medicare patients claims must be filed by
what editions fo the Federal Register would the outpatient facilities be interest in? November and December is when the Federal Register comes out and facilities are interested in.
Underw what act was a major change in Medicare in 1989 made possible? OBRA = Omnibus Budget Reconciliation Act 1989
Can a physician charge a patient to complete a Medicare form? No, a dr cannot charge the pt to fill out a Medicare form
________. Beneficiaries
The ______ ________ ________ do the paperwork for Medicare and are usually insurance companies that have bid for a contact with CMS to handle the Medicare program for a specific area. MACs
Medicare Part C is also known as ____________ ______ __________ Medical Advantage Organization - Part C
HIPAA stands for ______________ Health Insurance Portability Accountability Act 1996
The most major change to health care industry as a result of HIPAA was a result of what portion of the act? Administrative Simplification (major change due to HIPAA)
The transfer of electronic documentation is accomplished through the use of ______ _____ Interchange Technology. Electronic Data
The number assigned to all providers as a result of HIPAA: __________ _________ Indentifier. National Provider Identifier NPI
Relative Value Unit system _____ values are assigned to each service and are determined on the basis of the resources necessary to the physician's performance of the service. Units values are assigned
For Co-surgeons, Medicare pays the lesser of the actual charge of ____ % of the global fee, dividing the payment equally between the two surgeons. 125% (so each would get 62.5%)
Specific regulations for Medicare are contained in the ______ _____________ Manual Internet Only
Within an HUM, there is usually an individual who has been assigned to monitor the services provided to the patient both inside the facility and outside the facility. This person is known as the ______________. Gatekeeper
In this model of HMO, the HMO directly employs the physicians is a __________ Model Staff Model
In this model of HHO, the HMC contracts with the physician to provide the service at a set fee. This organization is known as ______ __________ Associations. Individual Practice Associations
An all inclusive care program for the elderly that provides a comprehensive package of services that permits the client to continue to live at home is known as a ________ for __________ - _________________ Care for the Elderly (PACE) PACE = Program -All Inclusive Care
Medicare Part A Hospital Insurance, Hospice services at home
Medicare Part B
Created by: dwall2674