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
