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