"hold harmless clause" * found in some non-Medicare health plan
contracts
* prohibits billing to patient for anything beyond
deductibles and co-pays.
A compliance plan may * more accurate payment of claims
offer several benefits, * fewer billing mistakes
including: * improved documentation and more accurate
coding
* less chance of violating self-referral and anti-
kickback status
A healthcare clearing entity that processes nonstandard health
house is a information they receive from another entity into a
standard format
A key provision in HIPAA only the minimum necessary protected health
is the Minimum information should be shared to satisfy a particular
Necessary requirement. purpose.
this means
A medically necessary least radical service/procedure that allows for
service is the effective treatment of the patients' complaint or
condition
A patient sustaining an Leg
injury to her great
saphenous vein would
have sustained injury to
which of anatomical
site?
APC Ambulatory Payment Classification
,ARRA American Recovery and Reinvestment Act (of
2009)
ASC Ambulatory Surgical Centers
Abuse consists of payment for items or services that are billed by
providers in error that should not be paid for by
Medicare.
An ABN protects the creating a paper trail that CMS requires before a
provider's financial provider can bill the patient for payment if Medicare
interest by denies coverage for the stated service or
procedure.
An entity that processes Clearinghouse
nonstandard health
information they receive
from another entity into a
standard format is
considered what?
As a part of Health Care intent
Reform, the Affordable
Care Act of 2010
amended the definition
of fraud to remove the
__________
requirement
By statute, all work every 5 years
RVUs, must be
examined no less often
than
CF Coversion Factor - fixed dollar amount used to
translate the RVUs into fees
, CMS Centers for Medicare and Medicaid
CMS developed polices Social Security Act
regarding medical
necessity are based on
regulations found in title
XVIII, $1862(a) of the
CMS will accept the CMS-R-131
____________ for either
a "potentially
non=covered" service or
for a statutorily excluded
service
CMS-R-131 ABN form
or
Advance Beneficiary Notice which explains to the
patient why Medicare may deny the particular
service or procedure.
CPT Current Procedural Terminology
CY 2013 Conversion $25.0008
Factor
Commercial (non- private contracts between the payer and practice
Medicare) may develop or provider
their own medical
policies which do not
follow Medicare
guidelines and are
specified in
DRG Diagnosis Related Group
contracts
* prohibits billing to patient for anything beyond
deductibles and co-pays.
A compliance plan may * more accurate payment of claims
offer several benefits, * fewer billing mistakes
including: * improved documentation and more accurate
coding
* less chance of violating self-referral and anti-
kickback status
A healthcare clearing entity that processes nonstandard health
house is a information they receive from another entity into a
standard format
A key provision in HIPAA only the minimum necessary protected health
is the Minimum information should be shared to satisfy a particular
Necessary requirement. purpose.
this means
A medically necessary least radical service/procedure that allows for
service is the effective treatment of the patients' complaint or
condition
A patient sustaining an Leg
injury to her great
saphenous vein would
have sustained injury to
which of anatomical
site?
APC Ambulatory Payment Classification
,ARRA American Recovery and Reinvestment Act (of
2009)
ASC Ambulatory Surgical Centers
Abuse consists of payment for items or services that are billed by
providers in error that should not be paid for by
Medicare.
An ABN protects the creating a paper trail that CMS requires before a
provider's financial provider can bill the patient for payment if Medicare
interest by denies coverage for the stated service or
procedure.
An entity that processes Clearinghouse
nonstandard health
information they receive
from another entity into a
standard format is
considered what?
As a part of Health Care intent
Reform, the Affordable
Care Act of 2010
amended the definition
of fraud to remove the
__________
requirement
By statute, all work every 5 years
RVUs, must be
examined no less often
than
CF Coversion Factor - fixed dollar amount used to
translate the RVUs into fees
, CMS Centers for Medicare and Medicaid
CMS developed polices Social Security Act
regarding medical
necessity are based on
regulations found in title
XVIII, $1862(a) of the
CMS will accept the CMS-R-131
____________ for either
a "potentially
non=covered" service or
for a statutorily excluded
service
CMS-R-131 ABN form
or
Advance Beneficiary Notice which explains to the
patient why Medicare may deny the particular
service or procedure.
CPT Current Procedural Terminology
CY 2013 Conversion $25.0008
Factor
Commercial (non- private contracts between the payer and practice
Medicare) may develop or provider
their own medical
policies which do not
follow Medicare
guidelines and are
specified in
DRG Diagnosis Related Group
