Ch 1: Content Review Flashcards
Reimbursement, HIPAA, and Compliance
T/F: Nationally, unit values have been assigned for each service by Medicare (CPT and HCPCS) and determined on the basis of the resources necessary for the physician’s performance of the service.
True
In the role as a medical coder, it is your responsibility to ensure that you code _____ and _____ to optimize reimbursement for services provided.
Accurately, Completely
CMS
Centers for Medicare and Medicaid Services
MAAC
Maximum Actual Allowable Charge
What edition of the “Federal Register” would hospital facilities be especially interested in?
October
The ____ program was developed by Congress to monitor the necessity of hospital admissions and review the treatment costs and medical records of hospitals.
?? PRO (Peer Review Organization)
This program is also known as Medicare Advantage.
Part C
What edition of the “Federal Register” would outpatient facilities be especially interested in?
November or December
What are the incentives to Medicare participating providers?
- Direct payment on all claims
- A 5% higher fee schedule
- Faster processing
The physician fee schedule is updated each April 15 and is composed of what?
- The relative value units for each service
- A geographic adjustment factor to adjust for regional variations in the cost of operations
- A national conversion factor
RBRVS
Resource Based Relative Value Scale
RBRVS
Resource Based Relative Value Scale
CMS handles the daily operation of the Medicare program through the use of ____ ____ ____, formerly Fiscal Intermediaries
Medicare Administrative Contractors
T/F: The “Federal Register” is the official publication for all “Presidential Documents,” “Rules and Regulations,” “Proposed Rules,” and “Notices.”
True
OBRA
Omnibus Budget Reconciliation Act
T/F: Kickbacks from patients are allowed under certain circumstances according to Medicare guidelines.
False
QIO
Quality Improvement Organization
Who handles the day-to-day operation of the Medicare program for the CMS?
MACs
Part B services are billed using what?
- ICD-10-CM
- CPT
- HCPCS
Medicare pays for what percentage of covered charges?
80%
Medicare sets the payment level for assistant surgeons at a percentage of the fee schedule amount for the _____ surgical service.
Global
Medicare Part B pays for what?
- Physician services
- Durable medical equipment
Under the RBRVS, the unit value is termed ____ Value Unit.
Relative
What are the three items that the Medicare beneficiaries are responsible to pay before Medicare will begin to pay for services?
- Deductibles
- Premiums
- Coinsurance
