Exam 1: Reimbursement, Hipaa, and Compliance

Match the Medicare part(s) with the coverage. -Prescription drug

QIO ________________________________________

If a surgeon performs more than one procedure on the same patient on the same day, and discounts were made on all subsequent procedures, Medicare would pay what percentages for the first, second, third, fourth, and fifth procedures?

Match the Medicare part(s) with the coverage. -Hospice care

Medicare sets the payment level for assistant surgeons at a percentage of the fee schedule amount for the ____ surgical service.

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 established these new benefits available under the Medicare program.

The ____________________ program was developed by Congress to monitor the necessity of hospital admissions and review the treatment costs and medical records of hospitals.

OBRA ________________________________________

RBRVS ________________________________________

Who is the largest third-party payer in the nation?

RVU ________________________________________

What edition of the Federal Register would hospital facilities be especially interested in?

The coder's responsibility is to ensure that the data are as accurate as possible not only for classification and study purposes but also to obtain appropriate reimbursement.

DHHS ________________________________________

The amount determined by multiplying the RVU weight by the geographic index and the conversion factor is called the __________ __________ amount.

The Federal Register is the official publication for all "Presidential Documents," "Rules and Regulations," "Proposed Rules," and "Notices."

The physician fee schedule is updated each April 15 and is composed of:

____ are activities involving the transfer of health care information and ____ means the movement of electronic data between two entities and the technology that supports the transfer.

The provider or facility is ____________________ when the payment goes directly to the patient.

A major change took place in Medicare in ____ with the enactment of the Omnibus Budget Reconciliation Act.