Medicare

Question 1

CMS

Answer 1

Center for Medicare and Medicaid Services

Question 2

CMS- 1500

Answer 2

Paper Standard form and Ambulance form (Part B)

Question 3

X12N 837P

Answer 3

Electronic form of CMS-1500

Question 4

ASCA

Answer 4

Administrative Simplification Compliance Act (mandate e-filing)

Question 5

Form 1490S

Answer 5

Beneficiary form

Question 6

RA

Answer 6

Remittance Advice (for unprocessed claims)

Question 7

Unprocessed claims

Answer 7

no initial determination- refile can not appeal

Question 8

RARC

Answer 8

Remittance Advice Remark Codes

Question 9

CARC

Answer 9

Claim Adjustment Reason Code

Question 10

Filing period

Answer 10

Jan-Sept file before Dec 31 of NEXT year (2015)

Oct-Dec file before Dec 31 of FOLLOWING year (2016)

Question 11

Penalties-late filing

Answer 11

Assigned claims- 10%

Unassigned claims- $2000

Question 12

OBRA

Answer 12

Omnibus Budget Reconciliation Act- req all assigned and unassigned claims get filed

Question 13

SOF

Answer 13

Signature on File

Question 14

MSP

Answer 14

Medicare Secondary Payer

Question 15

Medicare 1° to

Answer 15

TRICARE and MEDICAID

Question 16

COBA

Answer 16

Coordination of Benefits Agreement

Question 17

COBC

Answer 17

Coordination of Benefits Contractor

Question 18

N-key identifier

Answer 18

Assigned by Medicare contractor for crossover claims

Question 19

Crossover

Answer 19

the 2° payer must have signed a COBA with a COBC in order to obtain crossover claim filing

Question 20

NPI

Answer 20

National Provider Identifier

Question 21

UPIN

Answer 21

Unique Provider Identification Number

Question 22

Limiting Charge

Answer 22

Up to 15% that a non-participating provider may charge beneficiary (dx, test, drugs, op services supplies)

Question 23

ICD-9-CM

Answer 23

International Classification of Diseases-9th Revision Clinical Modification

Question 24

GHP

Answer 24

Group Health Plan

Question 25

MCR

Answer 25

Medicare Contracting Reform

Question 26

MMA

Answer 26

Medicare Prescription Drug, Improvement and Modernization Act of 2003

Question 27

MACs

Answer 27

Medicare Administrative Contractors

Question 28

ICD-10-CM | ICD-10-PCS

Answer 28

ICD-10 Clinical Modifications | ICD-10-Procedural Coding System

Question 29

NCHS

Answer 29

National Center for Health Statistics

Question 30

IPPS

Answer 30

Inpatient Prospective Payment Service

Question 31

MS-DRG

Answer 31

Medicare Severity- Diagnostic Related Group

Question 32

NEC

Answer 32

Not Elsewhere Classified

Question 33

NOS

Answer 33

Not Otherwise Specified

Question 34

CMS-1450 (UB-04)

Answer 34

Paper version Part A claims form

Question 35

ACS X12 Version 5010 (HIPPA 837)

Answer 35

Electronic form of CMS-1450

Question 36

HIPAA

Answer 36

Health Insurance Portability and Accountability Act of 1996

Question 37

NSC

Answer 37

National Supplier Clearinghouse

Question 38

EDI

Answer 38

Electronic Data Interchange (needed before file e-claims)

Question 39

EMC

Answer 39

Electronic Media Claims

Question 40

Clearinghouse

Answer 40

Private or public billing service (Info system mgmt, repricing etc)

Question 41

CLIA

Answer 41

Clinical Laboratory Improvement Amendment

Question 42

DMEPOS

Answer 42

Durable Medical Equipment Prosthetics, Orthotics and Supplies

Question 43

MA

Answer 43

Medicare Advantage (Part C)

Question 44

HICN

Answer 44

Health Insurance Claim Number (beneficiary info) | Medicare Claims Number

Question 45

Oct 15- Dec 7

Answer 45

Beneficiary MA Annual election period and Original FFS medicare enrollee can change Part D plans

Question 46

CMN

Answer 46

Certificate of Medical Necessity

Question 47

CPT

Answer 47

Current Procedural Terminology

Question 48

EHR

Answer 48

Electronic Health Records

Question 49

NCD

Answer 49

National Coverage Determinant | evidence based det by Medicare FFS contractors for a service that is reasonable and necessary

Question 50

LCD

Answer 50

Local Coverage Determinant | det by Medicare FFS contractors in the jusridiction when there is no NCD or need for further define NCD

Question 51

ABN

Answer 51

Advance Beneficiary Notice of Non-coverage

Question 52

MR

Answer 52

Medical Review

Question 53

MPFS

Answer 53

Medicare Physcisn Fee Schedule | Medicare Part B pays for services based on MPFS

Question 54

HCPCS

Answer 54

Healthcare Common Procedural Coding System

Question 55

NCCI

Answer 55

National Correct Coding Initiative - | code editing system

Question 56

CERT

Answer 56

Comprehensive Error Rate Testing | statistical sample to review if claims are properly paid

Question 57

MUE

Answer 57

Medically Unlikely Edits | Units of service edits

Question 58

RA

Answer 58

Remittance Advice

Question 59

MSN

Answer 59

Medicare Summary Notices

Question 60

PQRS

Answer 60

Physician Quality Reporting System

Question 61

PFS

Answer 61

Physician Fee Schedule

Question 62

VBP

Answer 62

Value Based Purchasing

Question 63

GPRO | PQRS

Answer 63

Group Practice Reporting Option

Question 64

MOC

Answer 64

Maintenance of Certification

Question 65

eRx

Answer 65

Electronic Prescribing