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ARM Information > Medicare > Flashcards

Medicare Flashcards

1
Q

CMS

A

Center for Medicare and Medicaid Services

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2
Q

CMS- 1500

A

Paper Standard form and Ambulance form (Part B)

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3
Q

X12N 837P

A

Electronic form of CMS-1500

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4
Q

ASCA

A

Administrative Simplification Compliance Act (mandate e-filing)

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5
Q

Form 1490S

A

Beneficiary form

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6
Q

RA

A

Remittance Advice (for unprocessed claims)

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7
Q

Unprocessed claims

A

no initial determination- refile can not appeal

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8
Q

RARC

A

Remittance Advice Remark Codes

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9
Q

CARC

A

Claim Adjustment Reason Code

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10
Q

Filing period

A

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

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

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11
Q

Penalties-late filing

A

Assigned claims- 10%

Unassigned claims- $2000

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12
Q

OBRA

A

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

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13
Q

SOF

A

Signature on File

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14
Q

MSP

A

Medicare Secondary Payer

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15
Q

Medicare 1° to

A

TRICARE and MEDICAID

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16
Q

COBA

A

Coordination of Benefits Agreement

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17
Q

COBC

A

Coordination of Benefits Contractor

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18
Q

N-key identifier

A

Assigned by Medicare contractor for crossover claims

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19
Q

Crossover

A

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

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20
Q

NPI

A

National Provider Identifier

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21
Q

UPIN

A

Unique Provider Identification Number

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22
Q

Limiting Charge

A

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

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23
Q

ICD-9-CM

A

International Classification of Diseases-9th Revision Clinical Modification

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24
Q

GHP

A

Group Health Plan

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25
Q

MCR

A

Medicare Contracting Reform

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26
Q

MMA

A

Medicare Prescription Drug, Improvement and Modernization Act of 2003

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27
Q

MACs

A

Medicare Administrative Contractors

28
Q

ICD-10-CM

ICD-10-PCS

A

ICD-10 Clinical Modifications

ICD-10-Procedural Coding System

29
Q

NCHS

A

National Center for Health Statistics

30
Q

IPPS

A

Inpatient Prospective Payment Service

31
Q

MS-DRG

A

Medicare Severity- Diagnostic Related Group

32
Q

NEC

A

Not Elsewhere Classified

33
Q

NOS

A

Not Otherwise Specified

34
Q

CMS-1450 (UB-04)

A

Paper version Part A claims form

35
Q

ACS X12 Version 5010 (HIPPA 837)

A

Electronic form of CMS-1450

36
Q

HIPAA

A

Health Insurance Portability and Accountability Act of 1996

37
Q

NSC

A

National Supplier Clearinghouse

38
Q

EDI

A

Electronic Data Interchange (needed before file e-claims)

39
Q

EMC

A

Electronic Media Claims

40
Q

Clearinghouse

A

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

41
Q

CLIA

A

Clinical Laboratory Improvement Amendment

42
Q

DMEPOS

A

Durable Medical Equipment Prosthetics, Orthotics and Supplies

43
Q

MA

A

Medicare Advantage (Part C)

44
Q

HICN

A

Health Insurance Claim Number (beneficiary info)

Medicare Claims Number

45
Q

Oct 15- Dec 7

A

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

46
Q

CMN

A

Certificate of Medical Necessity

47
Q

CPT

A

Current Procedural Terminology

48
Q

EHR

A

Electronic Health Records

49
Q

NCD

A

National Coverage Determinant

evidence based det by Medicare FFS contractors for a service that is reasonable and necessary

50
Q

LCD

A

Local Coverage Determinant

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

51
Q

ABN

A

Advance Beneficiary Notice of Non-coverage

52
Q

MR

A

Medical Review

53
Q

MPFS

A

Medicare Physcisn Fee Schedule

Medicare Part B pays for services based on MPFS

54
Q

HCPCS

A

Healthcare Common Procedural Coding System

55
Q

NCCI

A

National Correct Coding Initiative -

code editing system

56
Q

CERT

A

Comprehensive Error Rate Testing

statistical sample to review if claims are properly paid

57
Q

MUE

A

Medically Unlikely Edits

Units of service edits

58
Q

RA

A

Remittance Advice

59
Q

MSN

A

Medicare Summary Notices

60
Q

PQRS

A

Physician Quality Reporting System

61
Q

PFS

A

Physician Fee Schedule

62
Q

VBP

A

Value Based Purchasing

63
Q

GPRO

PQRS

A

Group Practice Reporting Option

64
Q

MOC

A

Maintenance of Certification

65
Q

eRx

A

Electronic Prescribing

ARM Information (5 decks)

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