Chapter 1 The Business of Medicine Flashcards
CMS
Centers for Medicare & Medicaid Services
NCD
National Coverage Determination
MAC
Medicare Administrative Contractor
LCD
Local Coverage Determination
ABN
Advanced Beneficiary Notice
HIPPA
Health Insurance Portability Accountability Act of 1996
HCPS
Healthcare Common Procedure Coding System
CPT
Current Procedural Terminology
CDT
Common Dental Terminology
ICD-9-CM
International Classification of Disease-9th Revision-Clinical Modification
NDC
National Drug Codes
NPI
National Provider Indentifier
EIN
Employer Identification Number
OCR
Office for Civil Rights
PHI
Protected Health Information
HITECH
Health Information Technology for Economic and Clinical Health Act
OIG
Office of Inspector General
HHS
Department of Health and Human Services
Coding
The process of translating a written or dictated medical record into a series of numeric and/or alpha-numeric codes.
Physician-Based Coding
Bill for physician work and overhead; they use CPT, HCPS, and ICD-9-CM volumes 1 and 2. Claim form used: CMS-1500
Hospital-Based Coding
Bill for technical component of services provided; they use CPT, HCPCS, ICD-9-CM volumes 1,2, and 3. Claim form used: UB-04.
EHR
Electronic Health Record
Medicare Part A
In-patient hospital care, as well as care provided in a skilled nursing facility, hospice care, and home-health care.
Medicare Part B
Medically necessary physician services, out-patient care, and other medical services note covered by Part A.
Medicare Part C
Managed by private insurers and may include a combination of Part A, Part B, and sometimes Part D.
Medicare Part D
Prescription drug coverage program available for Medicare beneficiaries.
Medical Record
Recording of pertinent facts and observations about an individual’s health.
Evaluation and Management Documentation
Subjective
Objective
Assessment
Plan
Subjective
The patient’s statement about their health, including symptoms.
Objective
The provider assesses and documents the patient’s illness using observation, palpation, auscultation, and percussion.
Assessment
Evaluation and conclusion made by the provider.
Plan
Course of action
National Coverage Determination
Spells out the CMS policies on when Medicare will pay for items or services.
Advanced Beneficiary Notice
Providers are responsible for obtaining an ABN prior to providing services or item to a beneficiary.
OIG Workplan
- Published yearly
- Outlines priorities for CMS; the public health agencies; the Administrations for Children and Families; and Administration on Aging.
- Target areas for improvement
