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Chapter 12, Medicare Medical Billing Flashcards

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14399505454Benefit PeriodLength of time during which benefits are paid0
14399506747Consolidated Omnibus Budget Reconciliation Act (COBRA)mandates an insurance program which gives some employees the ability to continue health insurance coverage after leaving1
14399508643Crossoverthe transfer of processed claim data from Medicare operations to Medicaid (or state) agencies and private insurance companies that sell supplemental insurance benefits to Medicare. beneficiaries.2
14399509822Electronic Remittance Advice (ERA)an electronic document that lists patients, dates of service, charges, and the amount paid or denied by the insurance carrier3
14399513116end-stage renal disease (ESRD)the final phase of chronic kidney disease4
14399515804Healthcare Common Procedure Coding System (HCPCS)A numeric and alphabetic coding system used for billing and pricing of procedures, medical supplies, medications, and durable medical equipment.5
14399518490Intermediariesthe transfer of processed claim data from Medicare operations to Medicaid (or state) agencies and private insurance companies that sell supplemental insurance benefits to Medicare. beneficiaries.6
14399520362limiting chargeThe maximum amount a physician may charge a Medicare beneficiary for a covered service if the physician does not accept assignment of the Medicare approved amount.7
14399522951Local Coverage Determination (LCD)notices sent to physicians with information about the coding and medical necessity of a service8
14399543779Medicare AbuseIncludes improper payments for items or services when there was no legal entitlement to that payment9
14399544813Medicare AdvantageMedicare Part C10
14399546772Medicare Administrative Contractor (MAC)contractor who handles claims and related functions11
14399547586Medicare Development LetterMedicare Development Letter A letter sent to a provider by Medicare requesting additional information or documentation to process a claim.12
14399551286Medicare FraudProviding false information to claim medical reimbursements beyond the scope of payment for actual healthcare services rendered.13
14399552998Medicare Part A (aka Hospital Insurance or HI)Provides hospital insurance automatically @ age 65 (if FICA qualified) @ no fee but may have deductible & co-pay.14
14399555991Medicare Part BThe part of the Medicare program that pays for physician services, outpatient hospital services, durable medical equipment, and other services and supplies.15
14399557945Medicare Part CMedicare Advantage Plans16
14399560515Medicare Part DPrescription drug coverage17
14399561293Medicare Remittance Notice (MRN)remittance advice from Medicare to providers that explains how payments for a batch of Medicare claims were determined18
14399570869Medicare Secondary Payer (MSP)The primary insurance must pay for any medical care before Medicare pays.19
14399573126Medicare Summary Notice (MSN)A summary sent to the patient from Medicare that summarizes all services provided over a period of time with an explanation of benefits provided20
14399575436Medigapa private insurance policy that pays the difference between the medical charge and the amount that Medicare pays21
14399576277Non-par MFSNon-PAR MFS Amount that applies to unassigned services performed by physicians and suppliers who choose not to participate in the Medicare program, which is 5% less than the MFS for participating providers. Providers who are non-PAR and not accepting assignment may charge a limiting charge of 115% of the nonparticipating fee amount.22
14399583144Office of the Inspector General (OIG)government agency that investigates and prosecutes fraud23
14399586522Program of All-Inclusive Care for the Elderly (PACE)PACE provides comprehensive medical and social services to certain frail, elderly people (participants) still living in the community. Most of the participants who are in PACE are dually eligible for both Medicare and Medicaid.24
14399587197Recovery Audit Contractor (RAC)program designed to audit Medicare claims25
14399588809ScrubbingThe term scrubbing refers to an in-depth 'cleaning' of a medical insurance claim prior to submission. ... In an ideal situation, the insurance payer checks the claim for any errors.26
14399590648Tax Relief and Healthcare Act (TRHCA)The Act provides for extensions and modifications of certain previously or soon to be expired tax relief provisions, extensions of certain expiring energy provisions, health savings account provisions and other general tax relief provisions.27
14399591325telemedicine/telehealth-Delivery of medical information and clinical services through interactive audiovisual media -Part of every health care provider's training28

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