Chapter 12, Medicare Medical Billing Flashcards
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| 14399505454 | Benefit Period | Length of time during which benefits are paid | 0 | |
| 14399506747 | Consolidated Omnibus Budget Reconciliation Act (COBRA) | mandates an insurance program which gives some employees the ability to continue health insurance coverage after leaving | 1 | |
| 14399508643 | Crossover | the 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 | |
| 14399509822 | Electronic Remittance Advice (ERA) | an electronic document that lists patients, dates of service, charges, and the amount paid or denied by the insurance carrier | 3 | |
| 14399513116 | end-stage renal disease (ESRD) | the final phase of chronic kidney disease | 4 | |
| 14399515804 | Healthcare 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 | |
| 14399518490 | Intermediaries | the 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 | |
| 14399520362 | limiting charge | The 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 | |
| 14399522951 | Local Coverage Determination (LCD) | notices sent to physicians with information about the coding and medical necessity of a service | 8 | |
| 14399543779 | Medicare Abuse | Includes improper payments for items or services when there was no legal entitlement to that payment | 9 | |
| 14399544813 | Medicare Advantage | Medicare Part C | 10 | |
| 14399546772 | Medicare Administrative Contractor (MAC) | contractor who handles claims and related functions | 11 | |
| 14399547586 | Medicare Development Letter | Medicare Development Letter A letter sent to a provider by Medicare requesting additional information or documentation to process a claim. | 12 | |
| 14399551286 | Medicare Fraud | Providing false information to claim medical reimbursements beyond the scope of payment for actual healthcare services rendered. | 13 | |
| 14399552998 | Medicare 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 | |
| 14399555991 | Medicare Part B | The part of the Medicare program that pays for physician services, outpatient hospital services, durable medical equipment, and other services and supplies. | 15 | |
| 14399557945 | Medicare Part C | Medicare Advantage Plans | 16 | |
| 14399560515 | Medicare Part D | Prescription drug coverage | 17 | |
| 14399561293 | Medicare Remittance Notice (MRN) | remittance advice from Medicare to providers that explains how payments for a batch of Medicare claims were determined | 18 | |
| 14399570869 | Medicare Secondary Payer (MSP) | The primary insurance must pay for any medical care before Medicare pays. | 19 | |
| 14399573126 | Medicare 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 provided | 20 | |
| 14399575436 | Medigap | a private insurance policy that pays the difference between the medical charge and the amount that Medicare pays | 21 | |
| 14399576277 | Non-par MFS | Non-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 | |
| 14399583144 | Office of the Inspector General (OIG) | government agency that investigates and prosecutes fraud | 23 | |
| 14399586522 | Program 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 | |
| 14399587197 | Recovery Audit Contractor (RAC) | program designed to audit Medicare claims | 25 | |
| 14399588809 | Scrubbing | The 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 | |
| 14399590648 | Tax 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 | |
| 14399591325 | telemedicine/telehealth | -Delivery of medical information and clinical services through interactive audiovisual media -Part of every health care provider's training | 28 |