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chapter 6: the regulation of public policy for elders

Terms in this set (78)

PROSPECTIVE PAYMENT
payment paid ahead of time based on preestablished amounts
CMS
Centers for medicare and Medicaid services
Medicare Act & became federal and state
1965 & 1966
OBRA
Omnibus budget reconciliation act 1987
HITECH act P.L.11-5
electronic records as a result of public policy will become a reality
Public regulated sources
>medicaid or title 18 of the social security act was first implemented in 1966.
>insurance program to supplement retirement, surviors, and disability insurance benefits.
>disability benefits for at least 24months those with end-stage renal disease, and
>those who elect to buy into the program
PPS
are rates established in advance based on the anticipated resource usuage by the medicafre beneficiary and are a pre-determined fixed amount
CPT
current procedural terminology codes. are revised annually and the amount of reimburstment is calculated on the basis of a number of factors
-Describe outcomes.
-may be billed once/day regardless of time(eval, splint, modalities) or timed codes
HCPCS level 2
another type of coding used for "products, supplies, and services not included in the CPT codes such as ambulance services and durable medical equipment, prosthetics, orthotics, supplies
LTAC
Long term acute care
For medically complex patients who need 25+ days of skilled care
CORF
Comprehensive outpatient rehabilitation facility
Correct Coding Initiative (CCI)
Policy used as a base to avoid misuse of billing procedures for a national coding methodology for Part B claims instituted by the CMS
Part C
health plans offered by private companies
Part D
is the outpatient prescribtion drug coverage an optional benefit
LCD
is a decision by a medicare administrative contractor (MAC) whether to cover a particular service
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