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Medical Billing, Insurance, and Coding - Smith Fall 2020 > Final Review > Flashcards

Flashcards in Final Review Deck (78)
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1

charging for a higher procedure than what was provided

upcode

2

individuals covered under Medicare

beneficiaries

3

who is responsible for the administration of the Federal Medicare program

DHHS

4

who is responsible for collecting and handling funds

Social Security Administration

5

largest third party payer

government through Medicare

6

Part A

Hospital insurance

7

Part B

Supplemental Insurance

8

coinsurance

20% medicare does not pay

9

computerized health record limited to one practice

EMR

10

the entire health record compiled from multiple sources

EHR

11

Where are national changes posted?

Federal Register

12

November/December Federal Register

Outpatient

13

October Federal Register

Hospital

14

Parts of RVU

Work
Overhead
Malpractice

15

practice expense

overhead

16

Amount of time, intensity, and technical expertise

work

17

total RVUs of a service is

sum of the units established for each component of the service

18

national dollar amount that is applied to all services paid on the basis of the Medicare Fee Schedule

conversion factor

19

limiting charge does not apply when

a nonphysician provider performs a technical component of a service that is on the fee schedule

20

percentage over the allowable

limiting charge

21

when do the general multiple-procedures not apply

when a CPT code description states "additional"

22

medicare set s the payment level for assistants-at-surgery at

16% of the fee schedule amount

23

how much of the global fee does medicare pay

125%

24

manages claims payment, oversees fiscal audit and/or overpayment prevention and recovery, and develops and monitors the payment safeguards necessary to detect and respond to payment errors or abusive patterns of service delivery

CMS

25

responsible for developing a work plan that outlines the ways in which the Medicare program is monitored to identify fraud and abuse

DHHS

26

oversees Medicare's payment safeguard program related to fraud, audit, medical review, collection of overpayments, imposition of civil monetary penalties for certain violations of medicare law (CMPS)

OBI

27

establishes the specific regulations in the Internet-Only Manuals for the providers and carriers to follow

CMS

28

group that is responsible for the health care services offered to an enrolled group or person, coordinates or manages the care of the enroller

MCO

29

primary care physician of the patient

gatekeeper

30

providers who form a network and provide services at a discounted rate

PPO