Chapter 7: Glossary questions well
answered to pass
Local Coverage Determination (LCD) - correct answer ✔✔Decision made by a
fiscal intermediary (FI) or a Medicare carrier about the services and items that are
reasonable and necessary. LCD also decides if a particular service should be
covered on an intermediary-wide or a carrier-wide basis, and it makes decisions
about the service that is reasonable and necessary for certain diagnoses and
procedure.
Medicare Administrative Contractor (MAC) - correct answer ✔✔A company under
contract with the federal government to handle claims processing for Medicare
services within a specific geographic jurisdiction.
Medical Necessity - correct answer ✔✔A decision made by a health plan as to
whether a treatment, test, or procedure is necessary for a patient's health or to
treat a diagnosed medical condition.
Medically Unlikely Edits (MUE) - correct answer ✔✔Part of NCCI edits that places
limits on the frequency that individual codes can be billed on a single date of
service by a single provider for a single beneficiary.
Modifier - correct answer ✔✔A two-character alpha-numeric code that affects the
meaning of another code.
National Correct Coding Initiative (NCCI/CCI) - correct answer ✔✔The National
Correct Coding Initiative (NCCI) is a CMS program designed to prevent improper
payment of procedures that should not be submitted together.
answered to pass
Local Coverage Determination (LCD) - correct answer ✔✔Decision made by a
fiscal intermediary (FI) or a Medicare carrier about the services and items that are
reasonable and necessary. LCD also decides if a particular service should be
covered on an intermediary-wide or a carrier-wide basis, and it makes decisions
about the service that is reasonable and necessary for certain diagnoses and
procedure.
Medicare Administrative Contractor (MAC) - correct answer ✔✔A company under
contract with the federal government to handle claims processing for Medicare
services within a specific geographic jurisdiction.
Medical Necessity - correct answer ✔✔A decision made by a health plan as to
whether a treatment, test, or procedure is necessary for a patient's health or to
treat a diagnosed medical condition.
Medically Unlikely Edits (MUE) - correct answer ✔✔Part of NCCI edits that places
limits on the frequency that individual codes can be billed on a single date of
service by a single provider for a single beneficiary.
Modifier - correct answer ✔✔A two-character alpha-numeric code that affects the
meaning of another code.
National Correct Coding Initiative (NCCI/CCI) - correct answer ✔✔The National
Correct Coding Initiative (NCCI) is a CMS program designed to prevent improper
payment of procedures that should not be submitted together.
