Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
44 Cards in this Set
- Front
- Back
|
The 2010 total US healthcare cost = _______% of GDP
|
17.7%
|
|
|
What % of the US 2010 budget is for Medicare
|
15%
|
|
|
What is the average $$ amount every person in the US spends on Medicare each year?
|
$1750/year
|
|
|
What does MACS stand for?
|
medicare administrative contractor
|
|
|
What is the function of MACS
|
they are private companies that contract with CMS to pay Medicare Part B claims
(blue cross & blue shield) |
|
|
An entity that has an agreement w/CMS to perform a project?
|
Contractors
(i.e., noridian administrative services) |
|
|
Part A conditions of Participation - state qualified anesthesia providers are?
|
CRNAs, MD/DO, Anesthesiologist, Oral Surgeons, Podiatrist, AAs
|
|
|
Part A - Supervison
Who can supervise? |
-does not need to be anesthesiologist
-anesthesia training not required -State "opt-out" permitted -Immediately available (able to conduct hands-on intervention |
|
|
What are the 16 states that have a "Opt-out" clause
|
alaska, idaho, iowa, kansas, minnesota, montana, etc...
|
|
|
Medicare interpretive guidelines are used by who? and for what reason?
|
used by surveyors such as medicare, JCAHO, state health departments to accredit healthcare facilities
|
|
|
The main function of Medicare part B is to:
|
set "requirements for providers to be paid for services"
|
|
|
Can CRNAs bill medicare directly?
|
yes...
|
|
|
What are "Q" modifiers?
|
Q modifiers indicate who provided the service
|
|
|
QX =
|
medically directed
|
|
|
QY =
|
medically directed 1:1 MD:CRNA
|
|
|
QZ =
|
non-medically directed
or Medically directed: 2:1 ratio |
|
|
QX (medically directed) occurs when?
|
an anesthesiologist fulfills the medical direction criteria for "up to" a maximum of 4 concurrent cases
|
|
|
Under QX (medically directed)
CRNAs entitled to _______% Anesthesiologist _______% |
50/50
|
|
|
Medicare part B criteria are:
1. conditions of payment 2. quality of care standards |
conditions of payments...
NOT quality of care standards |
|
|
Medical direction criteria (standards of payment!!) state: for each pt, to receive payment for medical direction, the MD must do "7" things?
|
1. pre-op exam & eval
2. prescribe the anesthetic plan 3. personally participate in the most demanding aspects of the anesthesia plan (induction/emerg) 4. Ensure any procedures that he/she does not perform are done by a qualified individual 5. Monitor the course of anesthesia admin. at frequent intervals 6. Remain physically present and available for immediate Dx and Tx of emergencies 7. provide indicated post-op care |
|
|
In order for "payment conditions to be met" (under medical direction requirements) the anesthesiologist must do what?
|
must document in the pt's medical record that he/she has met all 7 medical direction steps
|
|
|
Supervision vs. Medical Direct
(for each, determine) -Part A or Part B -What all falls under "medical direction" -What all falls under "supervision" |
Supervision (part A) :
-hospital participation -MD supervision required unless state opt-out Medical Direction (part B) -Provider payment -Rules of Payment |
|
|
CMS (center for Medicare and Medicaid services) was formerly known as?
|
HCFA - health care financing administration
|
|
|
Current Procedural Terminology (CPT codes) is a communication device that does what?
|
Identifies services (not dx's)
|
|
|
CPT codes are maintained by whom?
with a new edition printed each year in _______ |
maintained by AMA
October |
|
|
What is ICD?
|
international classification of disease
|
|
|
ICD is maintained by?
|
WHO
|
|
|
ICD-9-CM =
ICD-9-PCS = |
ICD-9-CM = Dx coding
ICD-9-PCS = hospital procedure coding |
|
|
What is HCPCS?
|
CMS "healthcare common procedure coding system"
|
|
|
HCPCS has two levels:
Level 1 = Level 2 = |
Level 1 = CPT-4 codes
Level 2 = procedures, services & supplies not in CPT-4 |
|
|
Anesthesia payment component:
base units = Time units = CF = |
base units = value of the procedure
Time units = time in 15 minute units CF = converts value of services into a dollar amount (specific to area) |
|
|
What is anesthesia payment formula?
|
(base units + Time units) x CF = Medicare payment in $$$
|
|
|
What is the conversion factor for the state of OHIO
|
21.37
|
|
|
What % of payment goes to each of the following?
-Medically directed (QX) = a. CRNA gets b. Anesthesiologist gets -Non-medically directed (QZ) a. CRNA gets |
QX = CRNA 50% / Anesth 50%
QZ = CRNA gets 100% |
|
|
QK =
|
4:1 ratio
|
|
|
What are the requirements for CRNAs to bill Medicare directly
|
-Certification
-Recertification -National provider ID (NPI) |
|
|
What is the NPI
|
national provider ID:
-linked to CRNA forever -moves with CRNA wherever he practices -speeds up payment |
|
|
Reimbursement of services rendered by SRNAs depends on what factors?
|
- # of students supervised
-who is supervising -Whether CRNA is medically/non-medically directed |
|
|
Can a non-medically directed CRNA bill medicare for teaching a SRNA
|
yes! Can bill for 100% of service if the CRNA remains "continuously" present
-if teaching a SRNA in each of 2 rooms can only bill for "Discontinuous time" |
|
|
What is the formula for billing Discontinuous time?
|
(base units + DCT units) x CF
|
|
|
If an anesthesiologist is teaching 1 SRNA or 1 Resident and is cont. present he can bill for?
|
100%
|
|
|
If an anesthesiologist is teaching and SRNA in 1 room and is supervising or medically-directing a CRNA, resident in a 2nd room....what can he bill for?
|
can bill 50% of SRNA case
|
|
|
If the anesthesiologist is teaching a resident in each of 2 rooms what can he bill for?
|
can bill for each room, but only for DCT
|
|
|
Medicare regulation of CRNAs
-Requires hospitals to determine? - And Defines? |
-requires hospitals to determine
a. who can give anesthesia b. qualifications for providers c. qualif. for supervisors -Defines a. who can direct anesthesia services b. when CRNA can work w/o supervision c. Diff. between anesthesia & analgesia d. who can bill |
