Medicare

Front 1

ADA publishes ___ coding manual

Back 1

Current Dental Terminology, CDT

Front 2

t/f
both HCPCS 1 (CPT) & HCPCS level II codes are often required to completely describe a service or procedure provided to a patient

Back 2

TRUE

Front 3

Durable medical equipment suppliers and manufacturers can call a _____with coding questions.

Back 3

SAMAC statistical analysis durable medical equipment contractor

Front 4

T/F
in CPT when a patient receives immune gobulin product also code an administration code as appropriate

Back 4

TRUE

Front 5

What types of codes are HCPCS Level I codes?

Back 5

CPT codes

Front 6

T/F
HCPCS codes are copyrighted by private organization

Back 6

false

Front 7

T/F
HCPCS are organized into 5 types , which depends on the purpose of the codes & the entity establishing & maintaing them

Back 7

true

Front 8

most state Medicaid programs use what type of system to report; professional services, procedures, supplies & equipment?

Back 8

HCPCS, health care common procedure coding system

Front 9

T/F
Lab services in HCPCS are listed in P codes grouping

Back 9

True

Front 10

HCPCS was developed by

Back 10

CMC, centers for medicare & medicaid services

Front 11

Crutches, wheelchairs, and walkers are examples of

Back 11

durable medical equipmentDME

Front 12

Effective December 31, 2003, ______ HCPCS codes were no longer required.

Back 12

Level III

Front 13

CPT is updated atleast

Back 13

annually

Front 14

T/F
HCPSC Level II codes are 4 alphanumeric codes used to present items not presented in CPT(level I) codes

Back 14

false

Front 15

T/F
HCPSC Level II modifers are 2 digit alpabetic suffixes

Back 15

false

Front 16

T/F
many radiology procedures include 2 parts; technical component & professional component

Back 16

true

Front 17

L codes represent which procedures/products?

Back 17

orthotics & prosthetic

Front 18

The best-known Medicare supplemental plan, designed by the government but sold by private commercial insurance companies, is _____

Back 18

Medigap

Front 19

T/F
the laws require that all medicare claims be filled using optical scanning guidlines

Back 19

True

Front 20

the IEP for medicare Part A & B is?

Back 20

7 months

Front 21

unpaid paper claims sent to medicare shud be resubmitted after how many days

Back 21

45

Front 22

medicare categorizes health maintenance organization (HMO), preffered provider organization (PPO) & place of service (POS) plans as

Back 22

coordinated care plans

Front 23

The act of billing a patient the difference between the charged fee and the Medicare allowed fee is ______

Back 23

balance billing

Front 24

A(n) ____begins with the first day of hospitalization and ends when the patient has been out of the hospital for 60 consecutive days

Back 24

benefit period

Front 25

who makes decisions on changing permanent codes?

Back 25

CMS, HIAA,BCBSA (blue cross/blue shield association)

Front 26

who are codes used for

Back 26

private & public health insurances

Front 27

who developed HCPCS II ?

Back 27

CMS

Front 28

when is it considered emergency?

Back 28

emergency is when your health is in serious danger

Front 29

How can you obtain an implied easement by previous use by a common grantor/owner? ______ + 3

Back 29

There must be a previous use by a common owner and this previous use must satisfy three requirements: [1] Continuous; [2] Apparent (open & obvious); [3] Reasonably necessary

Front 30

medigap policy

Back 30

provides reimbursement for out-of-pocket costs not covered by medicare & those that are the beneficiaries share of heath care costs

Front 31

Medicare part A

Back 31

hospital; inpatient care in hospitals, nursing facilities, & hospice.

Front 32

medicare benefit period

Back 32

begins w/first day of hospitalization and ends when the patient has been out for 60 days

Front 33

Level II permanent codes

Back 33

all 3 parties responsible for making decisions about additions, revisions, and deletions to permanent national alphanumeric codes

Front 34

DRGs

Back 34

Diagnosis Related Groups; a system to classify hospital cases into groups developed for medicare as part of the prospective payment system

Front 35

medigap policy

Back 35

provides reimbursement for out-of-pocket costs not covered by medicare & those that are the beneficiaries share of heath care costs

Front 36

Medicare part A

Back 36

hospital; inpatient care in hospitals, nursing facilities, & hospice.

Front 37

medicare benefit period

Back 37

begins w/first day of hospitalization and ends when the patient has been out for 60 days

Front 38

Level II permanent codes

Back 38

all 3 parties responsible for making decisions about additions, revisions, and deletions to permanent national alphanumeric codes

Front 39

DRGs

Back 39

Diagnosis Related Groups; a system to classify hospital cases into groups developed for medicare as part of the prospective payment system

Front 40

Balance Billing

Back 40

billing patients for any balance left over after deductibles, coinsurance, & insurance payments have been made

Front 41

Roster Billing

Back 41

enables medicare beneficiaries to participate in mass pneumonia and influenza virus programs

Front 42

case mix

Back 42

The types and categories of patients treated by a health care facility

Front 43

inpatient psychiatric facility payment prospective

Back 43

system which medicare reimburses inpatient psychiatric facilities according to patient classifaction

Front 44

participating provider

Back 44

contacts w/health insurance plan & accepts everything, the plan pays for procedures & services performed

Front 45

HCPCS

Back 45

Healthcare Common Procedure Coding System; it gives providers & suppliers a standard guide for reporting services, procedures, & equipment

Front 46

Part B

Back 46

physician services; outpatient hospital, durable medical equipment; premium & pay deductible until kicks in

Front 47

medicare general employment Period

Back 47

jan 1 - march 31 to those who wait til they turn 65 to apply

Front 48

per diem

Back 48

per day

Front 49

CDT Coding

Back 49

Current Dental Terminology; medical code set maintained & copyrighted by ADA

Front 50

ABN

Back 50

Advanced Beneficiary Notice;
acknowledges patient responsibility for payment if medicare denies the claim

Front 51

Medicare limiting charge for non participating providers

Back 51

the max amount that non-par provides are allowed to charge for services
ex/ Part B dont accept assignment)

Front 52

outpatient payment prospective

Back 52

uses ambulatory payment classifications to calculate reimbursements for billing hospital based medicare outpatient claims

Front 53

DRGs

Back 53

Shows how much payment the hospital receives.

Front 54

Deadline for filing claims

Back 54

Dec 31 of the year that services are rendered, unless it was Oct 1-Dec 31.-extended to Dec 31 of the following year.

Front 55

medicare select

Back 55

enrollees use a network of providers in order to receive full benefits,Lower premiums,
NOT pay benefits for nonemergency services

Front 56

non par provider

Back 56

Does not contract w/ insurance plan; higher out-of-pocket

Front 57

Medicare Summary Notice

Back 57

MSN; replaces explanation of benefits form; gives breakdown of medicare claims billed on patients behalf

Front 58

OASIS

Back 58

Outcome & Assessment Info Set; codes are determined after patient assessments

Front 59

ambulatory surgery center

Back 59

facility; minor surgical procedures are performed.person is outpatient who arrives in time for surgery & does not stay overnight

Front 60

RUGS

Back 60

Resource Utilization Groups-based on data collected from resident assessments & relative weights developed from staff time data

Front 61

Medicare enrollment- Automatically

Back 61

65-already get SS, RRB or disability are automatically enrolled. Part A and B

Front 62

Medicare enrollment- Applying

Back 62

3 mos before 65th b-day, or 24th month of disability.

Front 63

Penalty for not enrolling

Back 63

Have to pay a 10% penalty for each month that they waited to apply

Front 64

when is open enrollment?

Back 64

Have to wait until open enrollment Jan1-Mar 31st.

Front 65

Respite Care

Back 65

temp hospitalization for terminally ill that gives time off to person providing care for hospice patient

Front 66

hospice

Back 66

in/outpatient services of terminally ill patients & their families. patient is treated for pain & discomfort

Front 67

how are DRGs used

Back 67

to determine how much medicare pays the hospital

Front 68

why do we use modifiers

Back 68

to give additional info needed to process claim & get payment

Front 69

what does Part D cover

Back 69

Rx coverage;

Front 70

MEDICARE PART C

Back 70

SUPPLEMENTAL; pays copay

Front 71

deadline for filing claims

Back 71

dec 31, unless btwn oct 1 & dec 31, then extends to next year dec 31

Front 72

when is medicare primary

Back 72

employer less than 30 employees, not covered by any groups

Front 73

when is medicare secondary

Back 73

if individual or spouse has insurance from lGHP of 100>employees, workers comp, black lung, veterans, renal disease,disability 100>employees

Front 74

when does medicare pay for ambulance

Back 74

1.medically necessary-only safe way to transport3. transfer to & from locations 3.supplier meets medicare requirements

Front 75

medicare patents in psychiatric get ___ lifetime reserved days

Back 75

190

Front 76

T/F
all states allow balance billing

Back 76

false

Front 77

"this is not a bill" is seen at bottom of

Back 77

MSN

Front 78

palliative care for terminally ill patients is what type of care

Back 78

hospice

Front 79

The best-known Medicare supplemental plan, designed by the government but sold by private cmmercial insurance companies, is

Back 79

Medigap

Front 80

T/F
roster billing is used to submit single patient bills

Back 80

false

Front 81

T/F
all paper claims must be submitted on 1500 form

Back 81

true

Front 82

federally mandated program that requires states to cover just the Part B premium for a person whose income is slightly over poverty level is ____

Back 82

specified low-income medicare beneficiary program (SLMB)

Front 83

what process was developed to enable beneficiaries to participate in vaccination ?

Back 83

roster billing

Front 84

The law requires that all Medicare claims be filed using ___ guidlines

Back 84

optical scanning

Front 85

Part A covers

Back 85

inpatient hospital

Front 86

T/F
Part B includes annual deductible, 20% coinsurance after deductible is met

Back 86

true

Front 87

unpaid paper claims sent to medicare shud be resubmitted after how many days?

Back 87

45

Front 88

term SSA define as individuals inability to work as previously performed

Back 88

disability

Front 89

T/F
medicare covers investigational procedures

Back 89

false

Front 90

what is required w/claims for all unassigned surgeries = $55 or more

Back 90

surgery disclosure notice

Front 91

Medicare has established a ____agreement ;the provider contracts to accept assignments on all claims submitted to medicare

Back 91

participating providerPAR

Front 92

A ____ is the maximum fee a nonPAR may charge for a covered service,regardless who is responsible for payment & whether medicare is primary or secondary

Back 92

limiting charge

Front 93

T/F
medicare/medicaid crossover is available to ppl who have incomes below poverty level

Back 93

true

Front 94

the medicare explanation of benefits is called

Back 94

Medicare Summary NoticeMSN

Front 95

option did BBA of 1997 provide.lets providers drop out & enter private agreements

Back 95

private contracting

Front 96

T/F
law requires all medicare claims filled using optical scanning guidelines

Back 96

true

Front 97

T/F
patients must file medicare claims if they seek care from participating provider

Back 97

false

Front 98

which program pays for copays & deductibles

Back 98

supplemental plans

Front 99

DME claims must be sent to how many regional admin contractors?

Back 99

4

Front 100

instructions on info in part 3 are called

Back 100

medicare carriers manual