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Billing and Coding
Reimbursement, HIPAA , and Compliance
| Question | Answer |
|---|---|
| What two groups of persons were added to those eligible for Medicare benefits the initial establishment of the Medicare Program? | 1. A person eligible for disability benefits from social security. 2. Persons with permanent kidney failure. |
| To what government organization did the Secretary of the Department of Health and Human Services delegate the responsibility for administering the Medicare program? | (CMS) Center for Medicare & Medicaid Services now known as (NGS) National Government Services |
| What government organization handles the funds for the Medicare program? | Social Security Administration |
| There are three items that Medicare beneficiaries are responsible for paying before Medicare will begin to pay for services. What are these three items? | Premium. Deductible and Co-Insurance |
| Medicare publishes the Medicare fee schedule and usually pays what % of the amounts indicated for services? | 80% |
| The 3 components of work, overhead (practice expense), and malpractice are part of an RVU. What do the initials RVU stand for? | Relative Value Unit |
| According to the filling guidelines, providers must file claims for their medical patients within _____ months of the date of service. | 12 |
| What editions of the Federal Register would the outpatient facilities be interested in? | November and December |
| Under what act was a major change in Medicare in 1989 made possible? | (OBRA) Ominous Budget Reconciliation Act |
| Can a physician charge a patient to complete a Medicare form? | No |
| Individuals covered under Medicare are termed. | Beneficiaries |
| The _____ do the paperwork for Medicare and are usually insurance companies that have bib for a contract with CMS to handle the Medicare programs for a specific area. | Medical Administrative Contractors (MAC) |
| Medicare Part C is also known as | Medicare Advantage |
| HIPAA stands for. | Health Insurance Portability and Accountability Act |
| The most major change to the health care industry as a result a HIPAA was as a result of what portion of the act. | Administrative Simplification |
| The transfer of electronic documentation is accomplished through the use of _____ _____ Interchange technology. | Electronic Date |
| The number that is assigned to all providers as a result of HIPAA: _____ Identification. | National Provider |
| 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 services. | unit |
| 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 specialty. | Limiting |
| For co-workers, Medicare pays the lesser of the actual charge or _____% of the global fee, dividing the payment equally between the two surgeons | 125% |
| Specific regulations for Medicare are contained in the ____ ____ Manual. | Internet Only |
| Within an HMO, there is usually an individual who has been assigned to monitor the services provided to the patient both inside the facility and outside the facility. This Person is known as the _____ | Primary Care Physician (gate keeper) |
| In this model of HMO, The HMO directly employs the physicians _____ _____ Model | Group Practice |
| In the Model of HMO, The HMO contracts with the physician to provide the service at a set fee. These organizations are known as _______ _______ Associations. | Individual Practice Model |
| 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 _______ for ______-______ Care for the Elderly (PACE). | Program for All-Inclusive Care for the Elderly |
| Volume 3 of the ICD-9-CM is primarily used for by what type of medical facility? | Hospital |
Created by:
Wounderfuldana44
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