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29 terms

exam 11/19/10 #3

STUDY
PLAY
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