The Business Of Medicine Flashcards
Which Medicare part is reimbursed based on the risk adjustment models?
Part C Medicare advantage plans are reimbursed by CMS using risk adjustment models based on the health status of their members.
Who typically employees risk adjustment coders?
Health plans
Is a health plan required to follow the minimum necessary rule?
Yes, health plans are covered entities and are therefore required to follow the minimum necessary rule.
Which example below would be considered fraud?
Reporting a diagnosis or comorbidity that does not exist to obtain a higher reimbursement.
Which part of Medicare is also called Medicare advantage?
Part C Medicare part C also called Medicare advantage, combines the benefits of Medicare, part a, part, B, and sometimes part D.
What health insurance assistance program is sponsored by federal and state governments?
Medicaid is a health insurance assistance program for some low income people, especially children and pregnant women, sponsored by federal and state governments. It is administered on a state-by-state basis, but state programs must adhere to certain federal guidelines.
What 0IG document should a Medicare advantage participant review for potential problem areas that will receive special scrutiny in the upcoming year?
The OIG work plan twice a year, the OIG releases, a work plan, outlining its priorities for the fiscal year ahead. Of special interest to healthcare, the work plan announces potential problem areas with claim submissions that it will target for special scrutiny.
Which Code set is used by risk adjustment coders?
ICD – 10 – CM
Which regulation strengthens HIPAA rules, addressing privacy and security concerns associated with the electronic transmission of health information?
Health information, technology for economic and clinical health act HITECH
What is coding?
Translating a written, or dictated medical record into a series of alpha numeric codes.
