Overview Flashcards
AT
medicare modifyer
acute, active, restorative, arrest of progression, corrective care
GA
medicare modifier
maitentenance, ABN signed, patient know medicare won’t pay, can collect from patient
GZ
medicare modifier
you forgot to present the ABN to the patient, ABN was not signed, cannot collect from patient, medicare won’t pay
GY
medicare modifiers
statutorily exluded service
patient knowns medicare won’t pay, can collect from patient
GX
medicare modifier
statutorily excluded service
ABN voluntarily signed
can collect from patient
premium
amount patient has to pay per month
co-pay
set dollar amount due the day the patient is seen
co-insurance
% patient is responsible for
deductible
set dollar amount patient has to pay before insurance will kick in
explanation of benefits/remittance advice
provider calls insurance company to see what the insurance covered
verification
docor explains the benefits patient can receive
CMS
center for medicare and medicaid services
OIG
office of inspector general
looks for fraud
NPI
provider number
need one to enroll in medicare
MAC
medicare administrative center
day to day claim processing
