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