Billing Flashcards

1
Q

Title XVIII of the Social Security Act (SSA) is also known as…..

A

Medicare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The 4 qualifiers for Medicare are….

A

-elderly (65+)
-permanent disability
-end stage renal disease (ESRD)
-Lou Gehrig’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

I’m The 4 parts of Medicare are…

A

Part A
Part B
Part C
Part D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

MDCR Part A covers_______

MDCR Part B covers_______

MDCR Part C covers_______

MDCR Part D covers_______

A

A - Inpatient hospital stays
B - Medical (review chart)
C - advantage or replacement
D - Drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

5 types of Medicare Advantage plans

A
  • Health Maintenance Organizations (HMO)
  • Preferred Provider Organizations (PPO)
  • Private Fee-for-service plans
  • Special needs plans
  • Medical Savings Accounts (MSAs)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

MDCR advantage plan in which members must generally get healthcare from providers in the plan’s network is aka ______

A

HMO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

MDCR advantage plan in which members can see any doctor or provider that accepts Medicare and don’t need a referral for specialist is aka______

A

PPO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

MDCR advantage plan that allows members to go to any provider that accepts the plans terms is aka _______

A

Fee-for-service

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

MDCR advantage plan, which are limited to people in long-term care facilities (that are eligible for MDCR) and is only available in limited areas is aka _____

A

Special needs plans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

MDCR advantage plan with two parts, a high deductible, plan, and an account Medicare deposits, money into is aka _______

A

Medical Savings Accounts (MSAs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a formulary?

A

A list of medicare cover drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Private firms that process Medicare claims, enroll providers, provide education on billing requests, and answer provider and patient questions are also aka _____

A

Medicare administrative contractor (MAC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

DME stands for_______

A

Durable medical equipment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the advantages of the Medicare participating physician program?

A

-higher fee schedule payments
-fewer collection efforts
-publicity
-Government approval to display Medicare emblems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Are workers compensation regulations determined by the state or federal government?

A

State

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Who is eligible for Tricare? What is the exception?

A

-active duty, spouses, dependents, and retirees (unless they are Medicare eligible)

17
Q

The military member eligible for Medicare is called the ____

A

Sponsor

18
Q

Under Tricare, when does the sponsor become eligible for benefits? What about other members?

A

-sponsor - on the first day of active orders
-others - after sponsor has been in active duty for 30 days

19
Q

The Tricare supplement to Medicare is called ________

A

Tricare for Life

20
Q

What is a NAS and when is is required?

A

Non-availability Statement. It’s required before non emergent inpatient services at a non-military treatment facility.

21
Q

Title XXI of the Social Security Act is aka ________

A

CHIP - Children’s Health Insurance Program

22
Q

Who qualifies for CHIP and are the standards set by state or federal governments?

Is the program state or federally funded?

A

Children, whose families fail to qualify for Medicaid but cannot afford private insurance.

The states design the eligibility standards

It is jointly funded by state and federal governments

23
Q

Individual policies purchased by people who do not get insurance through an employer, are aka ____

A

Commercial Insurance Policies

24
Q

Medicare is secondary to…..(6)

A

-employer coverage (either patients or spouses extended coverage)
-work comp
-black link coverage
-auto
-liability
-VA*

25
Q

If a patient’s coverage changes to a Medicare HMO in the middle of an inpatient stay, is Medicare or the HMO responsible?

A

Medicare

26
Q

TRICARE is the last payer after other health plans except ______

A

Medicaid

27
Q

When is the VA primary to Medicare and vice versa?

A

The patient can choose the VA over Medicare, but must bill VA first. If patient chooses Medicare over, VA claim must be submitted to Medicare as primary and not submitted to the VA.

If Medicare is primary, no payment will be made by the VA

28
Q

Does liability and property casualty insurance fall as primary or secondary most of the time?

A

Primary

29
Q

Define the following HIPPA standard transportations
1. 835
2. 837 I/P
3. 279
4. 271
5. 267
6. 277

A
  1. 835 - healthcare payment remittance
  2. 837 I/P - institutional or professional claim file
  3. 270 - healthcare eligibility inquiry
  4. 271 - healthcare eligibility response.
  5. 267 - healthcare claim status inquiry.
  6. 277 - healthcare claim status response.
30
Q

When do you use the following?
-ICD 10
-POA
-CPT 4
-HCPCS

A

-ICD 10 - diagnosis an inpatient procedures
-POA - inpatient claims
-CPT 4 - outpatient procedures
-HCPCS - outpatient procedures

31
Q

What does AAHAM stand for?

A

American Association Healthcare Administrative Managment

32
Q

The two federal agencies governing healthcare change are CMS and OIG. What to those acronyms stand for?

A

CMS - Center for MDCR/MDCD Services
OIG - Office of Inspector General