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CPC-Reimbursement
CPC Study - Reimbursement Issues
| Question | Answer |
|---|---|
| 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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