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

Flashcards in Midterm Review Deck (16)
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1

charging for a higher procedure than what was provided

upcoding

2

is upcoding ethical?

NEVER

3

what is a third-party payer?

insurance company

4

largest third-party payer

government through Medicare

5

Part A

hospital insurance

6

Part B

Supplemental medical insurance

7

who is responsible for the administration of the Federal Medical program

DHHS (Secretary of the Department of Health and Human Services)

8

who is responsible for collecting and handling the funds

Social Security Administration

9

handles the daily operations of Medicare

CMS

10

insurance companies that bid for a contract with CMS

MACs

11

physicians, hospitals, and other suppliers that furnish care or supplies to Medicare patients

providers

12

Medicare pays for ___% of allowable charges

80

13

20% that Medicare does not pay

coinsurance

14

Beneficiary pays...

1. deductible
2. premiums
3. coinsurance (20%)
4. 100% of noncovered services

15

Medicare pays...

Covered services (80%)

16

amount of money an individual or business pays for an insurance policy

premium