Why hire Medicare Contractor Reviewers? - correct answer For Protection of Medicare Trust Fund.
Who is 1st of 6 Medicare Contract Reviewers? - correct
... [Show More] answer (MACs) Medicare Administrative Contractors
Whos is 2nd of 6 Medicare Contract Reviewers? - correct answer (RACs) Recovery Auditor Contractors
Who's 3rd of 6 Medicare Contractor Reviewers? - correct answer (CERTs) Comprehensive Error Rate Testing Contractors
Who's 4th of 6 Medicare Contract Reviewers? - correct answer (SMRCs) Supplemental Medical Review Contractors
Who's 5th of 6 Medicare Contract Reviewers? - correct answer (ZPICs) Zone Program Integrity Contractors
Who's 6th of 6 Medicare Contract Reviewers? - correct answer (UPICs) Unified Program Integrity Contractor
What are the MACs Responsible for? - correct answer Performed Medical Reviews of IPPS claims since 2008.
What's the purpose of a medical Review? - correct answer Validates Medicare payments are made on claims that are truly covered and correctly coded services and they are Med Nec
3 Types of Reviews? - correct answer *Automated
*Non Medical Record Review
*Medical Record Review "Complex Review"
An automated review includes? - correct answer Electronic info to detect improper payments. "technical denials"
*Wrong info/ Incomplete info on the claim.
What's the MCE? - correct answer Medical Code Editor! It checks accuracy of code assignment prior to grouping. ID's where an unacceptable code is used as P Dx, also when it's a duplicate or the p Dx and secondary don't match w/ pt age or gender
What do CMS data mining tools do? - correct answer Compare submitted codes against unacceptable p Dx
NCCI - correct answer National Correct Coding Initiative.
* Non-complex review.
*ID's improper Coding that lead to Improper Payments, Accurate assignment of modifiers to prevent denials
What 3 conventions are the coding policies based on? - correct answer *American Medical Association CPT manual, *National And local Medicare policies and edits and *Coding guidelines developed by national societies, standards and med
Non-medical Reviews? - correct answer *Manual intervention, determination based on only info included in claim,
*only performed on denials of related claims and
*when ADR is NOT submitted.
Complex Reviews? - correct answer Manual Review of health record! Medicare contract can review any info necessary to make determination.
What will the contractor review to make the determination? - correct answer *Official coding guidelines.
*AHA coding clinic [Show Less]