Exam 1: Reimbursement, Hipaa, and Compliance

If a QIO provider renders a covered service that costs $100 and bills Medicare for the service and Medicare allowed $58, the provider would bill this amount to the patient.

____ 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 conversion factor (CF) is a national dollar amount that is applied to all services paid on the basis of the ____________________.

Identify these acronyms. -OBRA ________________________________________

Identify these acronyms. -OIG ________________________________________

The incentive to Medicare participating providers is:

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

Nationally, unit values have been assigned for each service by Medicare (CPT and HCPCS) and determined on the basis of the resources necessary for the physician's performance of the service.

For endoscopic procedures, Medicare allows the full value of the highest valued endoscopy, plus the difference between the next highest endoscopy and the ____________________ endoscopy.

Identify the Medicare part with this coverage: Automatic coverage when age 65