link 4 ch 12
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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| This is a federal health insurance program for hospital coverage ages 65 or older, people younger that 65 with certain disabilities or end stage renal disease | show 🗑
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| This is a federal health insurance program for outpatient coverage that is a supplementary medical insurance benefits for the aged and disabled | show 🗑
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| What federal nationwide health insurance program for persons age 65 or older and certian disabled blind persons regardless of income, administered buy CMS. | show 🗑
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| This is an administrater of medicare that divides responsibilities among three divisions, and also enforces the insurance portability and transaction and code set requirements of HIPPA | show 🗑
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| show | the center for medicare management
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| show | the center for beneficiary choices
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| This part of CMS focuses on federal-stat programs such as medicaid, the state childrens health insurance program, insurance regulations, and the clinical lab improcement amendments. | show 🗑
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| show | custodial services
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| show | hospice
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| show | respite care
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| In the medicare program, monthly fee that enrollees pay for medicare part B medical insurance is called a | show 🗑
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| show | nonbenefits
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| This program was formed to increase the number of health care options in addition to those that are otherwise avalible | show 🗑
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| show | medicare part D
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| show | formulary
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| What specialized insurance policy is designed to supplement coverage under a fee-for-service medicare plan that may cover prescription cost and deductible and copayment that are typically the patients responsibility under medicare | show 🗑
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| A system of medicare reimbursement for HMOs with risk contracts in called | show 🗑
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| Informants who report physicians suspected of defrauding the federal government are called | show 🗑
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| An action to recover a penalty brought on by an informer in a situation in which one portion of the recovery goes to the informer and the other to the stat or government is known as | show 🗑
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| When a physician agrees to accept payment from medicare plus payment from the patient after the $165 deductible has been met is known as a | show 🗑
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| show | this means participating physician
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| show | nonparticipating physician
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| show | this means nonparticipating physician
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| show | assignment
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| show | limiting charge
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| show | notice of exclusions from medicare benefits
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| Also known as waiver of liability agreement or responsibility statment is an agreement given to the patient to read and sign before rendering service if the participating physician thinks that it may be denied for payment by medicare | show 🗑
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| show | (advance beneficiary notice of noncoverage)
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| NEMB | show 🗑
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| show | elective surgery
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| show | (correct coding initiative)
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| Federak legislation that attempts to eliminate unbundling or other inappropriat reporting of procedural codes for professional medical services rendered to patients is known as | show 🗑
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| This medicare part A program is a method of payment for medicare hospital insurance baced on DRGs ( a fixed dollar amount for a principal diagnosis) is known as | show 🗑
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| show | (prospective payment system)
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| show | reasonable fee
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| A sodument detailing services billed and describing payment determination issued to providers of medicare or medicaid program. also known as EOB is | show 🗑
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| show | crossover claim
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| MG | show 🗑
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| show | (center for medicare and medicaid services)
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| show | (supplemental security income)
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| show | supplemental sercurity income
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| DCGs | show 🗑
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| CLIA | show 🗑
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| RBRVS | show 🗑
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| show | resource-baced relative value scale
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| show | (relative value unit)
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| A monetary value assigned to each service on the basis of the amount of physician work, practice expenses, and cost of professional liability insurance. They are then adjusted according to geographic area and used in a formula to determin medicare fees | show 🗑
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| show | (physician quality reporting initiative)
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| show | physician quality reporting initiative
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| RAC | show 🗑
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| A proposal of legislation thats goals are to identify medicare underpayments and overpayments and recover overpayments using automated review and complex review in which after a complex review is done by human review of the record | show 🗑
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| ICF | show 🗑
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| An institution furnishing health-related care and services to individuals who so not require the degree of care provided by acut care hospitals or nursing facilities | show 🗑
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| show | (medicare summary notice)
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| show | medicare summary notice
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| show | (remittance advice)
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| show | (volume performance standard)
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| show | volume performance standard
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| A type of substitute coverage when a physician is on vacation is known as | show 🗑
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| A type of substitute coverage when on-call situations occur is known as | show 🗑
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