Chapter 1 - Reimursement, HIPAA, and Compliance
Terms in this set (41)
What two groups were added to those eligible for medicare benefits after the initial establishment of the Medicare program?
Those eligible for Social Security disability benefits.Those in end stage renal failure.
To waht government organization did the secretary of the Department of Health and Human Resources (DHHS) delegate the responsibility for administering the Medicare program?
Center for Medicaid and Medicare Service (CMS)
What three items are Medicare beneficiaries responsible for paying before Medicare will begin to pay for services?
co-insurance, deductible, premiums
Medicare usually pay what percent of the beneficiary's bill?
What does RVU stand for?
Resource Value Unit
What three components make up an RVU?
Work, overhead, and Malpractice
What does RBRVS stand for?
Resource Based Relative Value Scale
What does CMS stand for?
Center for Medicaid and Medicare Service
What program was developed by congress to monitor the necessity of hospital admissions and review the treatment costs and medical records of hospitals?
QIOs (Quality Improvement Organizations)
According to the filing guidelines providers must file claims for their medicare patients within how many months of the date of service?
MS-DRG reports what kind of services?
Hospital services or Part A services
What does QIO stand for?
Quality Improvement Organization
What facilities would be interested in the November and December editions of the Federal Register?
Under what act was a major change in Medicare in 1989 made possible?
OBRA (Omnibus Budget Reconciliation Act)
Can a physician charge a patient to complete a Medicare form?
What is the term for people covered under Medicare?
Medicare Advantage is/was known as what?
HIPPA stands for what?
Hospital Insurance Portability and Accountability Act
What portion of HIPPA caused the most major change to the health care industry? (hint: It's an oxymoron)
The transfer of electronic documentation is accomplished through the use of what Interchange technology?
What is the number assigned to all providers as a result of HIPPA is called?
National Provider Identification
What charge historically was specific for each physician but in 1993 the charge for a service was the same for all physicians within a locality, regardless of the specialty?
What percent of the global fee does Medicare pay for co-surgeons, dividing the payment equally between the two suregons?
Specific regulations for medicare are contained where?
The internet only manual
Within an HMO the individual who has been assigned to monitor the services provided to the patient both inside and outside the facility is known as what?
What model of HMO directly employs the physicians?
What model of HMO contracts with the physician to provide the services at a set fee?
Individual Practice Associations
What does PACE stand for?
Program for All-inclusive Care for the Elderly
What does OIG stand for?
Office of Inspector General
Department of Health and Human Rescources
What edition of the federal register would hospital facilities be interested in?
Relative value units for each service, a geographic adjustment factor to adjust for regional variations in the cost of operating a health care facility, and a national conversion factor compose what?
Physician Fee Schedule
Medicare sets the payment level for assistant surgeons at a percentage of the fee schedule amount for ______ surgical service.
Prescription drugs are covered by what part of Medicare?
Physician services and durable medical equipment are covered by what part of Medicare?
If a surgeon performs more than one procedure on the same patient on the same day, and discounts were made on all subsequent procedures, Medicare would pay what percentages for the first, second, third, fourth, and fifth procedures?
100% 50% 50% 50% 50%
____ are activities involving the transfer of health care information and ____ means the movement of electronic data between two entities and the technology that supports the transfe
Who handles the day-to-day operation of the medicare program?
When was Medicare established?
Medicare funds are collected by
Social Security Administration
What does MAC stand for?
Medicare Administrative Contractors