I & R Issue chap 5
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| Legal newspaper published every business day by the national archives and records administration | Federal Register
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| Contain new and changed Medicare policies and/or procedures that are to be incorporated into a specific CMS program | Program transmittals
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| 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
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| The assignment of ICD-9-CM diagnosis codes that does not match patient record documentation for the purpose of illegally increasing reimbursement | Upcoding
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| The storage of documentation for an established period of time. | record retention
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| An intentional description of misrepresentation that someone makes knowing it it is false that could result in an unauthorized payment. | Fraud
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| Involves actions that are inconsistent with accepted sound medicall business or fiscal practice. | Abuse
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| 2 examples of fraud | 1.Misrepresent the diagnosis to justify payment 2.Unbundling Codes
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| 2 examples of Abuse | 1. excessive charges for services2. violation of PAR agreements with insurance companies
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| Pairs of HCPCS and/or CPT Codes | CCI Edits
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| major procedure of service code | Column 1 Code
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| lesser procedure code | Column 2 code
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| Procedures or services that could not reasonably performed at the same session | Mutually exclusive codes
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| Reporting bundling procedure codes in addition to the major procedure code is characterized as _____________. | Unbundling
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| 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
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| Assigned to third party payers | national health planID
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| put on hold by congress | national individual identifier
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| Assigned to healthcare rpoviders | national provider identifier
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| Assigned to employers | national standard employer identification number (EIN)
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