Ch 9: Review Test (Part 2) Flashcards
Conquering Medicare's Challenges
What is the acronym for the quality reporting system that provided an incentive payment for eligible professionals (EPs) who satisfactorily reported data on quality measures for covered services furnished to Medicare beneficiaries?
PQRS
How many levels are there in the Medical appeals process?
5
The Patient Protection and Affordable Care Act included a provision that limited timely filing of Medicare claims to ____?
1 year from the date of service(s)
What are three exceptions to mandatory electronic claims submission?
- Small provider claims
- Roster billing
- Dental claims
What consists only of information pertaining to when a procedure is considered medically reasonable and necessary?
LCDs
A form that Medicare requires all healthcare providers use when a service is rendered that Medicare ordinarily covers but is likely to be denied on this particular occasion is the ____?
ABN
Some Medicare Advantage Plan enrollees are allowed to see specialists outside the “network” without going through a primary care physician. This is called ____?
Self-referring
The term commonly used when another insurance policy is primary to Medicare is ____?
Medicare Secondary Payer
A health insurance plan sold by private insurance companies to help pay for healthcare expenses not covered by Medicare is called a ____?
Supplemental policy
Beneficiaries can change their Medicare health or prescription drug coverage during the ____?
Annual open enrollment period
What is the program that provides community-based acute and long-term care services to Medicare beneficiaries?
PACE
