Abbreviations used in Medical Coding and Billing
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| RBRVS | Resource-Based Relative Value Scale
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| MEI | Medicare Economic Index
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| OBRA | (Medicare) Omnibus Budget Reconciliation Act of 1989
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| RVU | Relative Value Unit
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| Three Part of RVU | Work, Overhead, Malpractice
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| Work | Part of RVU that addresses the amount of time, intensity of effort, and technical expertise required to provide service.
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| Overhead | Part of RVU that addresses the practice expenses
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| Malpractice | Part of RVU that addresses the risk associated with providing the
service.
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| CF | Conversion Factor
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| Annually | How often is the CF updated?
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| Annual Updates to CF | Percent change to MEI, physician expenditures, relationship of expenditures to volume performance standards, and change in access and quality
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| Changes to CF varies according to these | type of service provided (medical, surgical, non-surgical)
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| MVPS | Medicare Volume Performance Standards
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| MVPS | government's estimation of how much growth is appropriate for nationwide physician expenditures paid for by Part B of Medicare.
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| Medicare claims must be paid by when? | within one year
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| Are providers allowed to charge for filing claims for Medicare patients? | No
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| If a claim is filed later than required, will the claim be paid? | No
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| Beneficiary Protection requires that participating providers accept payment how? | Accept the amount paid for eligible Medicaid services as payment in full.
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| Accepting Medicaid payment as payment in full was mandated by which law? | OBRA act of 1989
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| MAAC | Maximum Actual Allowable Charge
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| What does the MAAC limit? | Limitations are placed on nonparticipating physician charges -- in that the amount charged to Medicare beneficiaries cannot be more than the stated limiting charge.
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| Beneficiary Protections | 1. Claims must be filed within 12 months; 2. Accept Medicaid as payment in full; 3 Limiting Charges to Medicare beneficiaries
by nonparticipating providers
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| Limiting Charge does NOT apply to what types of services? | When a nonphysician performs the technical component of a service that is on the Medicare Physician Fee Schedule, the Limiting Charge does not apply. Use Modifier TC.
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| What is included under Limiting Charges? | Global, Professional, & Technical Services performed by any nonparticipating provider.
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| To whom do the Limiting Charges apply? | Non-participating physicians
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| How much is the Limiting Amount currently? | 115% of the Allowable amount
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| What does the Limiting Amount mean to the beneficiary? | That is the maximum amount that a nonparticipating provider can charge the Medicare beneficiary. The max of the balance-billing after M'care pays.
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| What percentage of the Allowable Amount will Medicare pay to participating providers? | 80% of the Fee Schedule amount
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| What is the maximum payment to non-participating providers? | 95% of the Fee Schedule amount
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| Where are Adjustments listed? | In the Physician Disclosure provided to all physicians during the participating enrollment period each year.
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| Are Participating Providers allowed to balance bill the Medicare beneficiary? | No.
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| Are Non-participating providers allowed to balance bill the Medicare beneficiary? | Yes, up to 115% of the Allowed Amount
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