Cards in this guide (46)
If a QIO provider renders a covered service that costs $100 and bills Medicare for the service and Medicare allowed $58, the provider would bill this amount to the patient:
Identify this acronym:OIG
Office of the Inspector General
Identify this acronym:RBRVS
Outpatient Resource - Based Relative Value Scale
A(n) (Blank) (three words), usually an insurance co., handles the daily operations for Medicare, including paper work, claims, and payments.
Medicare Administrative Contractors
A(n) (Blank) assignment is when a provider does not bill the patient for the difference between the service cost and Medicare allowed.
A medical coder's responsibility is to code accurately and (Blank).
The physician fee schedule is updated each April 15 and is composed of:
- Relative Value Units (RVUs)
2) Geographic adjustment factor to adjust for regional variations in the cost of operating a health care facility
3) A National Conversion Factor
The amount determined by multiplying the RVU weight by the geographic index and the conversion factor is called (Blank) (two words) amount.
The (Blank) (two words) is a national dollar amount that applied to all services paid on the basis of the MFS.
For endoscopic procedures, Medicare allows the full value of the highest valued endoscopy, plus the difference between the next highest endoscopy and the (Blank) endoscopy.
Identify the Medicare part with this coverage: "Automatic Coverage"
Part A
Ch.1, pg.5:
"Beneficiaries are automatically eligible for Part A..."
Identify the Medicare part with this coverage: "Hospice Care"
Identify this acronym:QIO
Quality Improvement Organizations
The conversion factor (CF) is a national dollar amount that is applied to all services paid on the basis of the (Blank).
Medicare Fee Schedule (MFS)
Select the three types of persons eligible for Medicare:
- those with disability benefits
2) those with permanent kidney failure
3) those 65 and over
Under the RBRVS, the unit value is termed (Blank) Value Unit.
What are the three items that the Medicare beneficiaries are responsible for paying before Medicare will began to pay for services
- deductibles
2) premiums
3) coinsurance
Identify this acronym:MAAC
Maximum Actual Allowable Charge
Medicare Part B pays for:
Physician services & durable Medical equipment
Medicare Part A pays for:
The Medicare program was established in:
(Blank) is the largest third-party payer in the U.S.:
The (Blank) is the fastest growing segment of the population.
Which group does the Medicare program NOT cover
Medicare Part (Blank) is a prescription drug benefit.
Identify this acronym:CMS
Centers for Medicare and Medicaid services
Medicare sets the payment level for assistant surgeons at a percentage of the "fee schedule" amount for the (Blank) surgical service.
Select the three components of the relative value unit.
- malpractice
2) work
3) overhead
A major charge took place in Medicare in (Blank) with the enactment of the Omnibus Budget Reconciliation Act. (OBRA)
Medicare pays for what percentage of covered charges
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 percentage for the first, second, third, fourth, and fifth procedures
1st - 100%
2nd - 50%
3rd - 50%
4th - 50%
5th - 50%
Nationally, unit values have been assigned for each service by Medicare (CPT and HCPCS) and determined on the basis of the resources necessary for the physician's performance of the service. (T/F)
The Federal Register is the official publication for all "Presidential Documents", "Rules & Regulations", "Proposed Rules" & "Notices". (T/F)
Identify this acronym:RVU
Identify the Medicare part with this coverage: "Prescription Drug"
What edition of the Federal Register would outpatient facilities be especially interested in
Identify the Medicare part with this coverage: "Physician visits"
Who handles the day-to-day operation of the Medicare program for the CMS
MACs (Medicare Administrative Contractors)
Fraud is an intentional 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 to himself/herself or some other person. (T/F)
(a)Blank) are activities involving the transfer of healthcare information and (b)Blank) means the movement of electronic data between two entities and the technology that supports the transfer.
(a) Transactions
(b) transmission
Who is the largest third-party payer in the nation
Identify this acronym:DHHS
Department of Health and Human Services
In the role as a medical coder, it is your responsibility to ensure that you code (Blank) and completely to optimize reimbursement for services provided.
Kickbacks from patients "areβ allowed under certain circumstances according to Medicare guidelines. (T/F)
Natioanally, unit values have been assigned for each service by Medicare (CPT and HCPCS) and determined on the basis of the resources necessary for the physicians performance of the service. (T/F)
Which of the following is NOT a stated goal of the Physician Payment Reform
Increase Medicare expenditures.
Ch.1, pg.11: "because they decrease."