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CPC Study - Reimbursement Issues

What is covered by Medicare Part A? Hospital and Institutional Care
What is covered by Medicare Part B? Supplemental - nonhospital (Physician services, medical equipment)
What is covered by Medicare Part C? Medicare Advantage Plans - PPO, HMO, PPFS, MSA, Special Needs Plans
What is covered by Medicare Part D? Prescription Drug Coverage (MA-PDs and PDPs)
What Department does the CMS answer to? Dept. of Health and Human Services
Who runs Medicare and Medicaid? The Centers for Medicare and Medicaid Services (CMS)
Who pays out Medicare claims? Medicare Administrative Contractors (MACs)
These codes are for drugs, supplies, equipment and special services: HCPCS codes
These are diagnosis codes: ICD-9 Codes
These are Procedural Codes: CPT Codes
What is unbundling? Billing multiple procedure codes for a group of procedures covered by a single comprehensive code.
Which issue of the Federal Register contains outpatient facility updates? November/December
What replaced the RBRVS? the NFS (National Fee Schedule)
This office outlines the Medicare monitoring program: OIG
What does an ABN notify a patient of? services probably not covered by Medicare and their estimated cost.
If both parents have insurance coverage, which one holds the primary coverage for the dependent? The parent with the birthday earliest in the calendar year.
What abbreviation signifies non-disposable medical equipment? DME
What is a Point of Service Plan? A plan where in-network providers are paid at a higher rate than out-of-network providers.
Management of multiple third-party payments to ensure overpayment does not occur: COB
CMS delegates the daily operation of Medicare to: MACs
A PAR Provider is one who: Signs and agreement with the MACs
Assignment Medicare's payment for service, which participating physicians agree to accept as payment in full
This is known as the APC: Outpatient Prospective Payment System
Who is the APC applicable to: Medicare patients
Special Report required to assist in the determination of the medical appropriateness of a service that is rarely provided, unusual, variable or new
Created by: dropgallow
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