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Medical Coding

Chapter 1 Reimbursement, HIPPA, and Compliance

QuestionAnswer
What two groups of persons were added to those eligible for Medicare benefits after the initial establishment of the Medicare program? Disabled and Permanent Renal Disease
To what government organization did the Secretary of the Department of Health and Human Services delegate the responsibility for administering the Medicare program? Centers for Medicare and Medicaid Services
What government organization handles the funds for the Medicare program? Medicare Administration Contractors or MAC's
There are three items that Medicare beneficiaries are responsible for paying before Medicare will begin to pay for services. What are these three items? Deductibles, Premiums, and Coinsurance payments
Medicare publishes the Medicare fee schedule and usually pays what percentage of the amounts indicated for services? 80%
What do the initials RVU stand for? Relative Value Unit
According to the filing guidelines, providers must file claims for their Medicare patients within ________ months of the date of service? 12
What editions of the Federal Register would the outpatient facilities be interested in? November and Decemebr
Under what act was a major change in Medicare in 1989 made possible? OBRA
Can a physician charge a patient to complete a Medicare form? No
Indiciduals covered under Medicare are termed Beneficiaries
The ____ _____ _____ do the paperwork for Medicare and are usually insurance companies that have bid for a contract with CMS to handle the Medicare program for a specific area. Medicare Administrative Contractors
Medicare Part C is also known as Medical Advantage Organization Part C
HIPPA stands for Health Insurance Portability Accountability Act 1996
The most major change to the health care industry as a result of HIPPA was a result of what portion of this act? Administrative Simplification
The transfer of electronic documentation is accomplished through the use of __________ ___________ Interchange technology. Electronic Data
The number that is assigned to all providers as a result of HIPPA:_______________ ___________ Identification National Provider
Under the 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 services. Units
The __________ charge historically was specific for each physician, but in 1993, the charge for service was the same for all physicians within a locality, regardless of specialty. Limiting
For co-surgeons, Medicare pays the lesser of the actual charge or _____% of the global fee, dividing the payment equally between the two surgeons. 125%
Specific regulations for Medicare are contained in the __________ _________ Manual Internet Only
Within an HMO, there are usually an individual who has beed assigned to monitor the services provided to the patient both inside the facility and outside the facility. This person is known as Gatekeeper
In this model of HMO, the HMO directly employs the physicians ________ model Staff
In this model of HMO, the HMO contracts with the physician to provide the service at a set fee. This organization is known as _________ __________ Associations. Individual Practice
An all-inclusive are program for the elderly that provided a comprehensive package of services that permits the client to continue to live at home is known as ________ for _______ __________ Care for the Elderly. Pace, Program All Inclusive
Created by: Harmony222