billing coding Flashcards
Part A
Hospital expenses, hospice, nursing facilities
Automatically enrolled
Patient pays a deductible but not a premium
Starts at age 65 and covers people who are disabled but below age 65.
Part B
Skilled nursing facility, hospice and home health
Optional
You get penalized if you do not take part B and are not working (10%)
Covers physician, outpatient, imms, labs, x-rays, chemo and dialysis
DME – like wheelchairs, walkers, cane, etc.
Covers 80% of outpatient and physician expenses
Part C
Advantage Plans
1997 Balanced Budget Act gave Medicare beneficiaries the option to receive their Medicare benefits through private health plans.
“C” means choice – they choose the plan
Many offer a combination of A, B and D for a price
Plan may have better coverage
Part D
Advantage plans and Prescription Drug Plans
pt are called
beneficiaries
Centers for Medicare and Medicaid Services (CMS) is the biggest user of
managed care HMO
Medicare HMO Emergency
Defined by them
Tricare=
champus
Advance Beneficiary Notice
Developed to protect Medicare patients form liability for services rendered that may or may not be necessary.
States that coverage has not yet been determined and that patient accepts responsibility for payment if Medicare does not
Patient Encounter Form
A form that will document the services and procedures that were provided to the patient.
Includes assessment and treatment data
Some include additional testing such as lab work that was ordered
May include follow-up recommendation
do not code usng
Probable
Suspected
Rule-out
Questionable
NEC =
Not elsewhere classifiable
Use only when there are no other alternatives
NOS =
not otherwise specified
Use only when there is not enough information to further classify the disease and assign a more specific code
E codes for
environemental events i.e poisonng, tornado, fire
place of occurance
global payments
Package Payment that the physician receives that encompasses several services and charges including: Pre-op visits, post-op visits, Complications after surgery, pain control, and medical supplies.
Post-op period includes all visits within 90 days of the surgery. Known as the “GLOBAL PERIOD”
