Overview Flashcards Preview

*Financial Management > Overview > Flashcards

Flashcards in Overview Deck (30):
1

AT

medicare modifyer
acute, active, restorative, arrest of progression, corrective care

2

GA

medicare modifier
maitentenance, ABN signed, patient know medicare won't pay, can collect from patient

3

GZ

medicare modifier
you forgot to present the ABN to the patient, ABN was not signed, cannot collect from patient, medicare won't pay

4

GY

medicare modifiers
statutorily exluded service
patient knowns medicare won't pay, can collect from patient

5

GX

medicare modifier
statutorily excluded service
ABN voluntarily signed
can collect from patient

6

premium

amount patient has to pay per month

7

co-pay

set dollar amount due the day the patient is seen

8

co-insurance

% patient is responsible for

9

deductible

set dollar amount patient has to pay before insurance will kick in

10

explanation of benefits/remittance advice

provider calls insurance company to see what the insurance covered

11

verification

docor explains the benefits patient can receive

12

CMS

center for medicare and medicaid services

13

OIG

office of inspector general
looks for fraud

14

NPI

provider number
need one to enroll in medicare

15

MAC

medicare administrative center
day to day claim processing

16

medical necessity

validates the reason we saw and are treating the patient

17

enrollment in medicare

gone through online process
have NPI
can be PAR or non-PAR

18

treatment plan

frequency of visits
next date for evaluation
prognosis
duration of treatment plan

19

HCPCS

deals with medical equipment and supplies

20

ICD-10 CM

diagnosis codes for patients

21

CPT/CMT

adjusting codes

22

who can see medicare patients

people who have NPI

23

what part of medicare covers chiropractic care?

part B and C

24

what is needed to prove medical necessity?

documentation has to line up with diagnosis codes and procedure and linked with pointer

25

how can you be eligible for medicare

65 or older
renal failure
ALS

26

what services will medicare pay for?

adjustments only

27

what order should you diagnose for medicare patietns?

1. subluxation (M99...)
2. diagnosis

28

how old can a date of onset be before medicare considers it maitenance?

31 days

29

where do the OIG find problems in records of chiropractors?

treatment plan
validating medical necessity
date of onset isn't the same day they saw the patient

30

what is re-validation? how often?

every 3-5 years
verifying and validating enrollment with medicare