"hold harmless clause" - ANS * 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: - ANS * 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 - ANS 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 - ANS only the minimum necessary protected health information should be shared to satisfy a particular purpose.
A medically necessary service is the - ANS 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? - ANS Leg
APC - ANS Ambulatory Payment Classification
ARRA - ANS American Recovery and Reinvestment Act (of 2009)
ASC - ANS Ambulatory Surgical Centers
Abuse consists of - ANS 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 - ANS 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? - ANS Clearinghouse
As a part of Health Care Reform, the Affordable Care Act of 2010 amended the definition of fraud to remove the __________ requirement - ANS intent
By statute, all work RVUs, must be examined no less often than - ANS every 5 years
CF - ANS Coversion Factor - fixed dollar amount used to translate the RVUs into fees
CMS - ANS Centers for Medicare and Medicaid
CMS developed polices regarding medical necessity are based on regulations found in title XVIII, $1862(a) of the - ANS Social Security Act
CMS will accept the ____________ for either a "potentially non=covered" service or for a statutorily excluded service - ANS CMS-R-131
CMS-R-131 - ANS ABN form
or
Advance Beneficiary Notice which explains to the patient why Medicare may deny the particular service or procedure.
CPT - ANS Current Procedural Terminology
CY 2013 Conversion Factor - ANS $25.0008
Commercial (non-Medicare) may develop their own medical policies which do not follow Medicare guidelines and are specified in - ANS private contracts between the payer and practice or provider
DRG - ANS Diagnosis Related Group
Does Medicare Part B generally require a yearly deductable and copayment? - ANS yes
E/M OR E&M - ANS Evaluation and Management
EHR - ANS Electronic Health Record
Formula for Calculating Facility Payment amounts - ANS [(Work RVU * Work GPCI) + (Transitioned Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * CF
Formula for Non-Facility Pricing Amount - ANS [(Work RVU * Work GPCI) + (Transitioned Non-Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * (CF)
GPCI - ANS Geographic Practice Cost Index
GPCI is used to - ANS realize the varying cost based on geographic location
HCPCS - ANS Healthcare Common Procedure Coding System
HHS - ANS Department of Health and Human Services
HIPAA provides federal protections for - ANS personal health information when held by covered entities.
HIPAA stands for - ANS Health Insurance Portability and Accountability Act of 1996
HITECH - ANS The Health Information Technology for Economic and Clinical Health Act
HITECH allows patients to request - ANS an audit trail showing all disclosures of their health information made through an electronic record.
HITECH requires that an individual be notified if - ANS there is an unauthorized disclosure or use of his or her health information.
HITECH was enacted as part of - ANS the American Recovery and Reinvestment Act of 2009 (ARRA)
HMO - ANS Health Maintenence Organization
Hemiplegia is a disorder caused by a defect in which anatomic system? - ANS nervous
ICD-9-CM - ANS 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 - ANS $39.51 Non-facility pricing amount [Show Less]