HSA 305 Final Exam Quiz - With Verified Answers (100% Correct)

HSA 305 Final Exam Quiz - With Verified Answers (100% Correct) Physician who accepts Medicare but does not agree to take assignment in all cases (they may on a case-by-case basis) and can charge up to 15% more than Medicare's approved amount for the cost of services received. Non-participating provider National dollar multiplier that sets the allowance for the relative values. Conversion factor Documents that describe the circumstances under which medical supplies, services, or procedures are covered nationwide by Medicare National coverage determination Set of edits that promote correct coding practices to control improper coding and prevent inappropriate payments National correct coding initiative The way CMS communicates policies and procedures for their payment systems' manuals to the MACs CMS transmittal Contains day-to-day operating instructions, policies, and procedures for Medicare Medicare claims processing manual Documents that provide the circumstances under which a service, procedure, or supply is considered medically necessary Local coverage determination Software that detects, and reports errors identified on Medicare inpatient claims Medicare code editor (MCE) Software that processes data for the Medicare hospital outpatient payment system pricing and audits facility claims data Outpatient code editor (OCE) Acronym for company that processes Medicare claims MAC Amounts owed to a facility Accounts receivable Report to provider that details claim outcome and payments Remittance advice Benefits statement for Medicare beneficiary payments and cost-sharing Medicare summary notices Type of accounting where AR amount is recorded at time of service Accrual accounting Amount that the payer agrees to reimburse for a service Allowable charge Statement that describes services delivered Explanation of benefits Type of accounting where AR amount is recorded at payment Cash accounting Determination of reimbursement amount based on health plan benefits Adjudication Internal auditing system used to run each claim through Scrubber The _____ is the difference between the charge and the allowable charge. Contractual allowance All of the following are examples of abuse, except: Knowing billing for a service that the provider did not furnish Which of the following compliance