HCCA CHC - Enterprise Wide Billing and Reimbursement Study Guide

HCCA CHC - Enterprise Wide Billing and Reimbursement Study Guide Medicare - Part A Insurance - Answer️️ -Inpatient Medicare - Part C Insurance (Medicare Advantage) - Answer️️ - Government managed care. Must be paying Part B Premiums to qualify. Medicare - Part B Insurance - Answer️️ -Outpatient/ MD Payment (members pay premium) Medicare - Part D Coverage - Answer️️ -Prescription Drug Coverage Def: Fiscal Intermediary (FI) - Answer️️ -Process for Medicare Part A Def: Carrier - Answer️️ -Part B, administers MD claims Def: Medicare Administrative Contractor (MAC) - Answer️️ -Applies to Fiscal Intermediary and Carriers Terminology: FMR - Answer️️ -Focused Medical Review Terminology: COPs - Answer️️ -Conditions of Participation Terminology - ICD-10-CM - Answer️️ -International Classification of Disease, Tenth Edition, Clinical Modification Terminology - DRGs - Answer️️ -Diagnosis Related Groups Terminology - CPT - Answer️️ -Current Procedural Terminology (CPT) ©SOPHIABENNET@ Thursday, August 22, 2024 10:21 AM 2 Terminology - HCPSC - Answer️️ -Health Care Common Procedure Coding System Def: Modifiers - Answer️️ -2 digit alpha-numeric code to modify payment Def: CMS Allowable - Answer️️ -Amount/maximum CMS allows for payment Def: Third Party Carrier - Answer️️ -Whoever CMS contracted with to process claims Def: Electronic Data Interchange (EDI) - Answer️️ -Standards by which claims are transmitted Def: Common Working File (CWF) - Answe