Ch 1: Chapter Review Flashcards
Reimbursement, HIPAA, and Compliance
What services are paid by Medicare Part A?
Hospital
What services are paid by Medicare Part B?
Physician
What services are paid by Medicare Part D?
Prescription Drugs
The Privacy Rule standards address the use and disclosure of individuals’ health information called _____?
Protected Health Information (PHI)
Updates of special interest to hospital facilities are published in which month in the “Federal Register”?
October
In the RBRVS system, payments for services are determined by the resource cost needed to provide them. The cost of providing each service is divided into what three components?
- Physician Work
- Practice Expense
- Malpractice
Who is responsible for developing an annual work plan to identify fraud?
Office of the Inspector General (OIG)
The purpose of managed health care is to provide _____ services and theoretically to _____ the health care services provided to the enrollee.
Cost-effective, improve
A list of allowable charges for Medicare services is called what?
Medicare Fee Schedule (MFS)
What is a national network of consumers, physicians, hospitals, and other caregivers, who work to refine care delivery systems at the state level, striving to improve the quality, timing, and cost of the care for Medicare patients.
Quality Improvement Organization (QIO)
What entity manages the process claims for CMS?
Medicare Administrative Contractor (MAC)
A group of providers who form a network to provide services to enrollees at a discounted rate is called what?
Preferred Provider Organization (PPO)
What is the official publication of all government “Rules and Regulations” and “Proposed Rules”?
Federal Register
Two insurance programs were established in 1965 by amendments to the Social Security Act known as Part _____ and Part _____.
Part A and Part B
The Secretary of DHHS has delegated responsibility for Medicare to which department?
CMS
