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Medicare review
| Question | Answer |
|---|---|
| CDT | Current Dental Terminology |
| CPT | Level 1 HCPCS Codes |
| HCPCS | Healthcare Common Procedure Coding System |
| HCPCS | Level 2 codes (also known as national) |
| HCPCS | Codes are organinzed by type of service |
| Injection | require 1 CPT (for the act of injecting) and 1 HCPCS code (for medicine) |
| Modifiers | Two digit code attached to procedure ti indicate alteration to procedure |
| Tabular index | Coding index in which procedures are listed in Numerical Order |
| Temporary Codes | may remain temporary forever |
| Ambulance Service | are only paid if no other transportation was available |
| Ambulatory Surgical Center | is a separate business entity, but may be located in hospital |
| Ambulatory Surgical Center | fee schedules are decided by Geographical Wage Index |
| Balance Billing | when provider attempts to bill patient what Medicare does not allow. (illegal) |
| Case Mix | the different types of patients within a health care facility |
| DRG | patient in groups according to diagnosis |
| DSM | only used by physician to describe mental |
| IPPS | Inpatient prospective payment system |
| IRVEN | software used for rehabilitation system |
| MPFS | formerly RBRVS, what Medicare allows for procedures |
| DSM | Diagnostic and Statisticl Manual |
| DRG | Diagnosis Related Group |
| MPFS | Medicare Physician Fee Schedule |
| Nonphysician Providers | must accept assignment |
| OASIS | used for patients receiving Home Health Care medical Service |
| Per diem | Latin for each day |
| RAVEN | software used for skilled nursing facilities |
| ABN | Advanced Beneficiary Notice |
| ABN | obtained before a procedure that Medicare is likely not cover. |
| Benefit Period | begins with fist day of hospitalization and ends when patient has been out for 60 consecutive days after discharge |
| coinsurance | must be collected by provider and failure to do so is punishable by fines |
| deadline for filing a claim with Medicare | one year from date of service |
| General Enrollment Period | held every year from jan 1st to march 31st |
| Hospice | program for both inpatient and outpatient care of teminally ill individuals |
| Initial Enrollment Period | first seven months after applying or turning 65 |
| Limiting Charge | Maximum amount that Nonpar may charge medicare enrollee |
| medicare secondary payer (msp) | info must be obtained first time patient is seen |
| Medicare fee Schedule | is developed by Medicare Administrative Contractors(MACS) |
| Medicare Select | type of Medigap that requires enrollees to use network of providers |
| Medicare Summary Notice | monthly statement that clearly lists health insurance info |
| Medigap | supplemental Medicare caoverage |
| NonPARs | may accept assingment on a claim by claim basis |
| Nurse Practitioner | must work with a physician |
| private contract | doctor opted out of medicare for two years cannot charge medicare but charge patient whatever they want |
| respite care | service offered to provide relief to non-paid family members who take care of terminally ill patient |
| roster billing | mass vaccinations, NO donations may be collected |
| part a | covers inpatient hospitalization, hospice care, home health facilities, skilled nursing facilities |
| part d | prescription drugs |
| special enrollment period | must prove you were unable to meet the first two time periods |
Created by:
quece79
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