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I & R Issue chap 5
Question | Answer |
---|---|
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) |