Step-By-Step ~ Ch. 1, part A

According to the filing guidelines, providers must file claims for Medicare patients within _______ months of the date of service.

12

For co-surgeons, Medicare pays the lesser of the actual charge or _______% of the global fee, dividing the payment equally betweenthe two surgeons.

125

Medicare publishes the Medicare fee Schedule and usually pays what percent of the amounts indicated for services??

80%

The most major change to the health care industry as a result of HIPAA was as a result of what portion of the act??

Administrative Simplification

Individuals covered under Medicare are termed ___________.

Beneficiaries

To what government organization did the Secretary of the Department of Health and Human Services delegate the responsibility for administering the Medicare program??

Centers for Medicare and Medicaid Services (CMS)

There are three items that Medicare beneficiaries are responsible for paying before Medicare will begin to pay for services. What are these three items??

Deductibles, premiums, and coinsurance payments

The transfer of electronic documentation is accomplished through the use of _________ _______ Interchange technology.

Electronic Data

Within an HMO, there is usually an individual who has been assigned to monitor the services provided to the patient both inside the facility and outside the facility. This person is known as the _________________.

Gatekeeper

HIPAA stands for __________ __________ __________ & _________ ____.

Health Insurance Portability & Accountability Act

In this model of HMO, the HMO contracts with physician to provide the service at a set fee. This organization is known as ___________ ___________ Associations.

Individual Practice

Specific regulations for Medicare are contained in the ________ ________ Manual.

Internet Only

The ___________ ____________ ___________ do the paperwork for Medicare and are usually insurance companies that have bid for a contact with CMS to handle the Medicare program for a specific area.

Medicare Administrative Contractors

Medicare Part C is known as _____________.

Medicare Advantage

The number that is assigned to all providers as a result of HIPAA: __________ ___________ Identification.

National Provider

Can a physician charge a patient to complete a Medicare form??

No, they can only charge for actual service rendered

What editions of the Federal Register would the outpatient facilities be interested in??

November and December

Under what act was a major change in Medicare in 1989 made possible??

Omnibus Budget Reconciliation Act (OBRA)

An all-inclusive care program for the elderly that provides a comprehensive package of services that permits the client to continue to live at home is known as __________ for ___________ __________ Care for the Elderly (PACE).

Program, All-inclusive

The three components of work, overhead (practice expense), and malpractice are part of an RVU. What do the initials RVU stand for??

Relative Value Unit

What government organization handles the funds for the Medicare program??

Social Security Administration

In this model of HMO, the HMO directly employs the physicians _________ __________ .

Staff Model

Under the Relative Value Unit system, _________ values are assigned to each service and are determined on the basis of the resources necessary to the physician's performance of the service.

Unit

What two groups of persons were added to those eligible for Medicare benefits after the initial establishment of the Medicare program??

a) Persons eligible for disability benefits from Social Security. b) persons with permanent kidney failure.

The __________ charge historically was specific for each physician, but in 1993, the charge for a service was the same for all physicians within a locality, regardless of the specialty.

limiting