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
Who administers funds for Medicare?
Social Security Administration
Who is eligible for Medicare?
- 65 and over
- Disability benefits
- Permanent kidney failure
Three components of the relative value unit are work, overhead (or practice expense), and _____.
Malpractice
What does RBRVS stand for?
Resource Based Relative Value Scale
What is the fastest growing segment of our population today?
Elderly
What is the name given to the groups that handle the daily operations of the Medicare program?
MACs (Medicare Administrative Contractors)
Intentional deception of misrepresentation is known as _____.
Fraud
Quality Improvement Organizations were previously termed _____.
PROs (Peer Review Organization)
MS-DRG assignment reports _____ services.
Part A
October editions of the “Federal Register” are of special interest to _____.
Hospital Facilities
OBRA 1990 contained modifications and clarifications regarding the _____.
Physician fee schedule
