Reimbursement, HIPPA, and Compliance
Terms in this set (38)
What two groups of persons were added to those eligible for Medicare benefits after the initial establishment of the Medicare program?
In stage renal and Those eligible for disability from Social Security
To what government organization did the Secretary of the Department of Health and Human Services delegate the responsibility for administering the Medicare program?
(CMS) Center for Medicare and Medicaid Services
CMS abbreviation for
Center for Medicare and Medicaid Services
What government organization handles the funds for the Medicare program?
There are three items that Medicare beneficiaries are responsible for paying before Medicare will begin to pay for services. What are these three items?
deductible, premiums and coinsurance
Medicare publishes the Medicare fee schedule and usually pays what percentage of the amounts indicated for services?
The three components of work, overhead (practice expense), and malpractice are part of an RVU. What do the initials RVU stand for?
Relative Value Unit
According to the filing guidelines, providers must file claims for their Medicare patients within ______ months of the date of service.
What editions of the Federal Register would the outpatient facilities be interested in?
November and December Editions
Under what act was a major change in Medicare in 1989 made possible?
(OBRA) Omnibus Budget Reconciliation Act
What does the abbreviation OBRA stand for?
Omnibus Budget Reconciliation Act
Can a physician charge a patient to complete a Medicare form?
The __________ ____________________ ____________ do the paperwork for Medicare and are usually insurance companies that have bid for a contract with CMS to handle the Medicare program for a specific area.
Medicare Administrative Contractors
Medicare Part C is also known as
HIPAA stands for
Health Insurance Portability and accountability Act
Individuals covered under Medicare are termed
The most major change to the health care industry as a result of HIPAA was as a result of what portion of the act?
The transfer of electronic documentation is accomplished through the use of _________ ______ interchange technology
The number that is assigned to all providers as a result of HIPAA: ___________ _________ Identification
What does NPI stand for?
National provider Identification
Under the Relative Value Unit system, ______________ values are assigned to each service and are determined on the basis of the resources necessary to the physician's performance of the service.
The _________ charge historically was specific for each physician, but in 1993, the charge for service was the same for all physicians within a locality, regardless of the specialty.
For co-surgeons, Medicare pays the lesser of the actual charge or __________ % of the global fee, dividing the payment equally between the two surgeons.
Specific regulations for Medicare are contained in the __________ __________ Manual.
Within an HMO, there is usually an individual who has been assigned to monitor the services provided to the patient both inside the facility and outside the facility. This person is known as the
In this model of HMO, the HMO directly employs the physicians.
An all-inclusive care program for the elderly that provides a comprehensive package of services that permits the client to continue to live at home is known as ___________ for _______-________ Care for the Elderly (PACE)
The major third-party payer in the United States is the
The Medicare program was established in what year?
Hospital Insurance is ___________ _________ ____
Medicare Part A
Supplemental Medical Insurance is _________ _______ _____
Medicare Part B
Which edition of the Federal Register is of special interest to hospital facilities?
Which edition of the Federal Register is of special interest to outpatient facilities?
November or December
Which is the Federal Register is the issuing office
Department of Health and Human Services
What is the Action
What does RBRVS stand for
Resource Base relative Value Scale
The Medicare Economic Index is published in what publication?
In 1989, a major change took place in Medicare with the enactment of