Step-By-Step Medical Coding Chapter 1: Reimbursement, HIPAA, and Compliance 105 Questions with 100% Correct Answers – COMPLETE SOLUTION

Step-By-Step Medical Coding Chapter 1: Reimbursement, HIPAA, and Compliance 105 Questions with 100% Correct Answers – COMPLETE SOLUTION Document Content and Description Below Step-By-Step Medical Coding Chapter 1: Reimbursement, HIPAA, and Compliance 105 Questions with 100% Correct Answers – COMPLETE SOLUTION What 2 groups of persons were added to those eligible for Medicare benefits after the initial establishment of the Medicare program? - 1. Persons eligible for disability benefits from Social Security 2. Persons with permanent kidney failure requiring dialysis or transplant To what government organization did the Secretary of the Department of Health and Human Services delegate the responsibility for administering the Medicare program? - CMS (Centers for Medicare and Medicaid Services) What government organization handles the funds for the Medicare program? - Social Security Administration There are 3 items Medicare beneficiaries are responsible for paying before Medicare will begin to pay for services. What are these 3 items? - 1. Deductibles 2. Premiums 3. Coinsurance Medicare publishes the Medicare fee schedule and usually pays what percentage of the amounts indicated for services? - 80% The 3 components of work, overhead (practice expense), and malpractice are part of an RVU. What do the initials RVU stand for? - Relative Value Unit According to the filing guidelines, providers must file claims for their Medicare patients within ________ months of the date of service. - 12What 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? - OBRA Can a physician charge a patient to complete a Medicare form? - No Individuals covered under Medicare are termed - Beneficiaries The ____________ ______________ ______________ do the paperwork for Medicare and are usually insurance companies that have bid for a contract with CMS to handle the Medicare program for a specific area. - Medicare Administrative Contractors (MACs) Medicare Part C is also known as - Medicare Advantage HIPAA stands for - Health Insurance Portability Accountability Act The most major change to the health care industry as a result of HIPAA was a result of what portion of the act? - Administrative Simplification The transfer of electronic documentation is accomplished through the use of ______________ ____________ Interchange technology. - Electronic Data The number that is assigned to all providers as a result of HIPAA is the - National Provider Identification 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 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. - LimitingFor co-surgeons, Medicare pays the lesser of the actual charge or __________% of the global fee, dividing the payment equally between the two surgeons. - 125 Specific regulations for Medicare are contained in the __________________ __________________ Manual. - Internet Only 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 In this model of HMO, the HMO directly employs the physicians. - Staff Model In this model of HMO, the HMO contracts with the physician to provide the service at a set fee. These organizations are known as _____________ _____________ Associations. - Individual Practice 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 Medicare Program was established in 1965 with the passage of the - Social Security Act Physicians, hospitals, and other suppliers that furnish care or supplies to Medicare patients are termed - Providers _______________________ means that the provider will accept what Medicare allows and not bill the patient the difference. - Accepting assignment Hospitals report services for ___________________ services by using ICD-10-CM codes and the MS-DRG assignment - Part A The _____________ is the largest 3rd party payer in the nation - Government