Business of Medicine Flashcards
Describe a medically necessary service?
Using the least radical service/procedure that allows for effective treatment of the patient’s complaint or condition.
According to the example LCD from Novitas Solutions, which of the following conditions is considered a systemic condition that may result in the need for routine foot care?
Chronic venous insufficiency
What form is provided to a patient to indicate a service may not be covered by Medicare and the patient may be responsible for the charges?
Advance Beneficiary Notice (ABN)
T/F ABNs may not be recognized by non-Medicare payers.
True
When presenting a cost estimate on an ABN for a potentially non-covered service, the cost estimate should be within what range of the actual cost?
$100 or 25 percent
Who would NOT be considered a covered entity under HIPAA? Doctors, HMOs, Clearinghouses, Patients
Patients
Under HIPAA, what would be a policy requirement for minimum necessary?
Only individuals whose job requires it may have access to protected health information.
Which act was enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA) and affected privacy and security?
Health Information Technology for Economic and Clinical Health Act (HITECH)
What document assists provider offices with the development of compliance manuals?
Office of Inspector General (OIG) Compliance Program Guidance
What document is referenced when looking for potential problem areas identified by the government indicating scrutiny of the services?
Office of Inspector General (OIG) Work Plan
ABN
Advance Beneficiary Notice
AMA
American Medical Association
APC
Ambulatory Payment Classification
ARRA
American Recovery and Reinvestment Act 2009
ASC
Ambulatory Surgical Centers
CMS
Center for Medicare & Medicaid Services
CMS-HCC
Center for Medicare & Medicaid Services- Hierarchical Condition Category
CPC
Certified Professional Coder
CPT
Current Procedural Terminology
HCPCS
Healthcare Common Procedure Coding System
Health Insurance Portability and Accountability Act
HIPAA
HITECH
Health Information Technology for Economic and Clinical
ICD 10 - CM
International Classification of Disease, 10th revision, Clincal Modification
LCD
Local Coverage Determination
