exam 11/19/10 #3

29 terms by aftinlee 

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the duration of time during which a medicare benificiary is eligible for part A benefits for in-hospital or skilled nursing facility is called a /an

benefit period

how many parts are there to the medicare program?

4

individuals pay for medicare part B through what?

premiums

beneficiaries who are not satisfied with the amount of a claim reimbursement may file a/an

appeal

what is the term used when medicare is not responsible for paying first because of coverage under another insurance policy

medicare secondary payer

how many levels are there in the medicare appeals process?

5

medicare's fee schedule is based on a system whereby each payment value is found within a range of payments known as?

resource based relative value system (RBRVS)

what is the act that established quality standards for all laboratory testing to ensure safety, accuracy, reliability, and timeliness?

clinical laboratory improvement act (CLIA)

medicare payments can be automatically deposited into a provider's designated bank account using

electronic funds transfer (EFT)

studies performed to improve the processes and outcomes of patient care are called what?

quality review study

is it the coder's responsibility to ensure all data is as accurate as possible not only for classification and study purposes but also to obtain approproate reimbursement?

yes

are national unit values assigned for each service by medicare (cpt and hcpcs), and determined on the basis of the resources necessary for the physician's performance of the service?

yes

according to medicare guidelines, are kickbacks allowed under certain circumstances?

no

what year was the medicare program established?

1965

what does medicare part B pays for?

physician and outpatient charges

what percentage does medicare pay for covered charges?

80%

what is the incentive for physician's to participate in the medicare program?

5% higher fee schedule, direct payment, faster processing of claims.

who is the largest third party payer in the nation?

the government

medicare sets the payment level for assistants at surgery at a percentage of the fee schedule amount for the __?___ surgical service

global

what edition of the federal register would hospital facilities be especially interested in?

october

what edition of the federal register would outpatient facilities be especially interested in?

november and december

what are the three items that medicare beneficiaries are responsible to pay befor medicare will begin to pay for services?

deductibles, premiums, and coinsurance

what organization collects the medicare funds?

the social security administration

this program (part) of medicare is also known as medicare advantage

part c

CMS handles the daily operation of the medicare program though the use of __?__, formally fiscal intermediaries

medicare administrative contractors (MACS)

CMS

CENTERS OF MEDICARE AND MEDICAID SERVICES

RBRVS

RESOURCE BASED RELATIVE VALUE SYSTEM

OIG

OFFICE OF THE INSPECTOR GENERAL

DHHS

DEPARTMENT OF HEALTH AND HUMAN SERVICES

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