The Business of Medicine Flashcards
MS-DRG stands for:
Medicare Severity-Diagnosis Related Groups
EHR stands for:
Electronic health record
APCs stands for:
Ambulatory Payment Classifications
What is a PA
Physician Assistant. PA’s are mid-level providers also known as “physician extenders”. PA’s are licensed to practice medicine with physician supervision. A PA’s program takes approximately 26 1/2 months to complete
What is an NP
Nurse Practitioner. NP is a mid-level provider or “physician extender”. NP’s have a Master’s Degree in Nursing.
CMS stands for:
Center for Medicare & Medicaid Services
ESRD stands for:
End stage renal disease
Medicare Part A covers:
Helps pay for IP hospital care as well as skilled nursing, hospice and home health.
Medicare Part B covers:
Helps pay for medically necessary provider services and preventive services. This is an optional benefit for which the patient pays a monthly premium, an annual deductible, and generally has a 20% co-insurance.
Medicare Part C covers:
or Medicare Advantage, combine Part A & B and sometimes D. The plan is managed by private insurers approved by Medicare.
Medicare Part D covers:
Helps pay for prescription drug programs available to all Medicare beneficiaries for a fee.
What are SOAP Notes
Evaluation and Management (E&M) services are provided in a standard format such as SOAP.
S-Subjective - The patient’s statement about his or her health, including symptoms.
O-Objective - The provider’s examination and documentation of the patient’s illness using objective. palpation, auscultation, and percussion. Tests and other services may be documented here as well.
A-Assessment - Evaluation and conclusion made by the provider. This is usually where the diagnosis that supports the services is found.
P-Plan - Course of action. Here the provider will list the steps for the patient, i.e., ordering additional tests, taking over-the-counter meds, etc.
What does “Medical Necessity” mean:
Relates to whether the procedure or service is considered appropriate in a given circumstance. (CMS has developed policies based on regulations found in title XVIII of the SS Act. The National Coverage Determinations Manual describes whether specific services can be paid for under Medicare).
What is “NCD” :
National Coverage Determinations. NCD explain when Medicare will pay for items. Each Medicare Administrative Contractor (MAC) interprets national policy into regional policy. These are called Local Coverage Determinations (LCD).
What is an “ABN”:
Advanced Beneficiary Notice. Provider’s use this form (entitled Revised ABN CMS-R-131) when the service provided the Medicare may not cover. (Medicare may not pay for the service related to the patient’s condition, or as frequently as the proposed service or for an experimental service.
