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CRCR
Question | Answer |
---|---|
What is ABN | Advance Beneficiary Notice |
How many elements in a Compliance Program? | 16 |
What does FERA stand for? | Fraud Enforcement and Recovery Act, amends the FCA - False Claim Act in 2009 |
What are the Code of Conduct areas? | Human Resources Privacy/ confidentiality Quality of care Billing/ Coding Conflicts of Interest Laws/Regulations |
What is OIG? | Office of Inspector General |
What makes up the OIG Work Plan? | 1. Outpatient Evaluation and management services billed at the new patient rate. 2. Indirect medical education payments. 3. Medicare Costs associated with defective medical devices. 4. Comparison of provider-based and free standing clinics. 5. Nationw |
What are the secondary payer situations? | working aged, accident or other liability, disability ESRD |
What does DME stand for? | Durable Medical Equipment, examples, wheelchairs, beds, oxygen tanks |
What does CMS stand for? | Centers for Medicare and Medicaid Services |
What does LCD and NCD stand for? | Local Coverage Determinations, National Coverage Determinations, guidelines for which procedures, diagnoses are covered |
What does MSP stand for? | Medicare Secondary Payer. |
List four situations for MSP? | working aged, accident/liability, ESRD, disability |
HMO | Health Maintenance Organization |
PPO | Preferred provider Organization |
POS | point of service plan |
CDHP | Consumer Directed Health Plans |
DRG | Diagnosis related group |
APC | Ambulatory Payment Classification |
EMTALA | Emergency Medical Treatment And Labor Act |
MS-DRG | Medicare Severity Diagnosis-Related Group |
LGHP | Large group health plan |