"hold harmless clause"
* found in some non-Medicare health plan contracts
* prohibits billing to patient for anything beyond deductibles and
... [Show More] co-pays.
A compliance plan may offer several benefits, including:
* more accurate payment of claims
* fewer billing mistakes
* improved documentation and more accurate coding
* less chance of violating self-referral and anti-kickback status
A healthcare clearing house is a
entity that processes nonstandard health information they receive from another entity into a standard format
A key provision in HIPAA is the Minimum Necessary requirement. this means
only the minimum necessary protected health information should be shared to satisfy a particular purpose.
A medically necessary service is the
least radical service/procedure that allows for effective treatment of the patients' complaint or condition
A patient sustaining an injury to her great saphenous vein would have sustained injury to which of anatomical site?
Leg
APC
Ambulatory Payment Classification
ARRA
American Recovery and Reinvestment Act (of 2009)
ASC
Ambulatory Surgical Centers
Abuse consists of
payment for items or services that are billed by providers in error that should not be paid for by Medicare.
An ABN protects the provider's financial interest by
creating a paper trail that CMS requires before a provider can bill the patient for payment if Medicare denies coverage for the stated service or procedure.
An entity that processes nonstandard health information they receive from another entity into a standard format is considered what?
Clearinghouse
As a part of Health Care Reform, the Affordable Care Act of 2010 amended the definition of fraud to remove the __________ requirement
intent
By statute, all work RVUs, must be examined no less often than
every 5 years
CF
Coversion Factor - fixed dollar amount used to translate the RVUs into fees
CMS
Centers for Medicare and Medicaid
CMS developed polices regarding medical necessity are based on regulations found in title XVIII, $1862(a) of the
Social Security Act
CMS will accept the ____________ for either a "potentially non=covered" service or for a statutorily excluded service
CMS-R-131
CMS-R-131
ABN form
or
Advance Beneficiary Notice which explains to the patient why Medicare may deny the particular service or procedure.
CPT
Current Procedural Terminology
CY 2013 Conversion Factor
$25.0008
Commercial (non-Medicare) may develop their own medical policies which do not follow Medicare guidelines and are specified in
private contracts between the payer and practice or provider
DRG
Diagnosis Related Group
Does Medicare Part B generally require a yearly deductable and copayment?
yes
E/M OR E&M
Evaluation and Management
EHR
Electronic Health Record
Formula for Calculating Facility Payment amounts
[(Work RVU Work GPCI) + (Transitioned Facility PE RVU PE GPCI) + (MP RVU MP GPCI)] CF
Formula for Non-Facility Pricing Amount
[(Work RVU Work GPCI) + (Transitioned Non-Facility PE RVU PE GPCI) + (MP RVU MP GPCI)] (CF)
GPCI
Geographic Practice Cost Index
GPCI is used to
realize the varying cost based on geographic location
HCPCS
Healthcare Common Procedure Coding System
HHS
Department of Health and Human Services
HIPAA provides federal protections for
personal health information when held by covered entities.
HIPAA stands for
Health Insurance Portability and Accountability Act of 1996
HITECH
The Health Information Technology for Economic and Clinical Health Act
HITECH allows patients to request
an audit trail showing all disclosures of their health information made through an electronic record.
HITECH requires that an individual be notified if
there is an unauthorized disclosure or use of his or her health information.
HITECH was enacted as part of
the American Recovery and Reinvestment Act of 2009 (ARRA)
HMO
Health Maintenence Organization
Hemiplegia is a disorder caused by a defect in which anatomic system?
nervous
ICD-9-CM
International Classification of Disease, 9th Clinical Modification
IF:
Work RVUs = 0.48
Work GPCI = 1.000
Practice Expense CPCI = 0.943
MP GPCI = 0.572
transitioned non-facility practice RVUs = 0.70
Calculate non-facility pricing amount for cpt code 99212 using 2011 CF of $33.9764
$39.51 Non-facility pricing amount [Show Less]