ICD Coding Chapter 1

STUDY
PLAY

Terms in this set (...)

Part A
Automatic coverage under Social Security
Part B & C
Optional coverage under Social Security
Part A
Hospice care coverage
Part D
Prescription drug coverage
Part B
Physician visit coverage
Part B
Beneficiary pays premium for coverage
Part B
Codes assigned for payment using diagnoses; CPT; and HCPCS
Government
The major third-party payer in the United States is the ____?
1965
The Medicare program was established in what year?
Part A
Hospital Insurance is Medicare, Part ____?
Part B
Supplemental Medical Insurance is Medicare, Part ____?
October edition
Which edition of the Federal Register is of special interest to hospital facilities?
November & December edition
Which edition of the Federal Register is of special interest to outpatient facilities?
Resource-Based Relative Value Scale
What does RBRVS stand for?
Federal Register on June 16, 1975
The Medicare Economic Index is published in what publication?
Omnibus Budget Reconciliation Act of 1989 (OBRA)
In 1989, a major change took place in Medicare with the enactment of ____?
Fraud
This term is the international deception or misrepresentation that an individual knows to be false or does not believe to be true and makes knowing that the deception could result in some unauthorized benefit.
Office of the Inspector General (OIG)
This organization develops a work plan to identify areas of the Medicare program that will be monitored.
Gatekeeper/Physician
The physician responsible for controlling and managing the health care of an HMO enrollee is the ____?
Program for All-Inclusive Care for the Elderly (PACE)
What does the abbreviation PACE stand for?
Part A & B
Two insurance programs were established in 1965 by amendments to the Social Security Act known as Part __ and Part __?
Centers for Medicare and Medicaid Services (CMS)
The Secretary of DHHS has delegated responsibility for Medicare to which department?
Social Security Administration
Who administers funds for Medicare?
Persons 65 or older, on disability, or in end-stage renal failure
Who is eligible for Medicare?
Work, overhead, malpractice
What are the three components of the relative value (RVU) unit?
Resource-Based Relative Value Scale
What does RBRVS stand for?
Elderly
What is the fastest growing segment of our population today?
Medicare Administrative Contractors (MACs)
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.
PROs
Quality Improvement Organization were previously termed ____?
Part A
MS-DRG assignment reports ____ services.
Physician Fee Schedule
OBRA 1990 contained modifications and clarifications regarding the ____.
Deductible, Premiums, and Coinsurance
There are three items that Medicare beneficiaries are responsible for paying before Medicare will begin to pay for services. What are the three items?
80%
Medicare publishes the Medicare Fee Schedule and usually pays what percentage of the amounts indicated for services?
12
According to the filing guidelines, providers must file claims for their Medicare patients within ___ months of the date of service.
No
Can a physician charge a patient to complete a Medicare form?
Beneficiaries
Individuals covered under Medicare are termed ____.
Medicare Advantage Organization
Medicare Part C is also known as _____.
Health Insurance Portability and Accountability Act
HIPAA stands for ______.
Administrative Simplification Portion
The most major change to the health care industry as a result of HIPAA was a result of what portion of the act?
Electronic Data Interchange (EDI)
The transfer of electronic documentation is accomplished through the use of ______ technology.
National Provider Identification
The number that is assigned to all providers as a result of HIPAA:
Unit
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.
Limiting
The ____ 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 speciality.
125 %
For c0-surgeons, Medicare pays the lesser of the actual charge or _____ of the global fee, dividing the payment equally between the two surgeons.
Internet Only Manual (IOMs)
Specific regulations for Medicare are contained in the ______.
Staff Model
In this model of HMO, the HMO directly employs the physicians.
Individual Practice Association
In this model of HMO, the HMO contracts with the physician to provide the service at a set fee. These organizations are known as ______.
Program for All-Inclusive Care for the Elderly (PACE)
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 _____.