Questions and Answers
What does A/B MACs (HHH) stand for?
What does A/B MAC (A) process?
What does ABN stand for?
Advanced Beneficiary Notice of Non-Coverage
What is the meaning of CBSA?
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What is CCN in Medicare terminology?
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What does CLIA stand for?
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What is COP in a healthcare context?
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What does CWF stand for?
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What does DCN mean?
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What is DDE in medical billing?
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What does DMEPOS represent?
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What is dNWPT?
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What does DOEBA stand for?
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What is DOLBA?
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What do DRGs refer to?
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What does EDI stand for?
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What does EFT represent?
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What are FIPS?
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What does FISS stand for?
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What does FVR stand for?
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What is HETS?
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What does HHEH stand for?
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What is HHRG?
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What does HIPAA stand for?
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What is HIPPS?
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What does ICD stand for?
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What is IPF?
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What does iQIES stand for?
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What does LTCH stand for?
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What is MA in healthcare?
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What does MBI stand for?
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What is MTF?
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What does NOA stand for?
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What is NUBC?
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What does OPPS stand for?
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What is PDGM?
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What does PPS stand for?
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What is RA in healthcare?
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What does RFA stand for?
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What does RFA4 represent?
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What is RIC in healthcare?
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What does TOB stand for?
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Study Notes
Medicare Administrative Processes
- A/B MACs (HHH) are the Medicare Administrative Contractors responsible for handling various claims.
- A/B MAC (A) specifically processes hospital claims within the Medicare system.
Key Medicare Documents and Notices
- ABN stands for Advanced Beneficiary Notice of Non-Coverage, informing beneficiaries about non-covered services.
- CCN is the CMS Certification Number, a unique identifier for providers under Medicare.
- CLIA refers to the Clinical Laboratory Improvement Amendments, ensuring quality standards in laboratory testing.
Compliance and Statistical Measures
- COP, or Conditions of Participation, outlines the requirements facilities must meet to participate in Medicare.
- CBSA stands for Core Based Statistical Area, used for statistical purposes in health care.
Administrative Metadata
- CWF is the Common Working File, data storage for provider claim information.
- DCN refers to the Document Control Number for tracking claims and documents.
- DDE is known as Direct Data Entry, a method for submitting Medicare claims directly.
Durable and Home Health Supplies
- DMEPOS includes Durable Medical Equipment, Prosthetics, Orthotics, and Supplies covered under Medicare.
- dNWPT is Disposable Negative Pressure Wound Therapy, a specific type of care funded by Medicare.
Billing and Claims Processes
- DOEBA stands for Date of Earliest Billing Activity, critical for tracking billing timelines.
- DOLBA refers to Date of Latest Billing Activity, essential for understanding claim cycles.
- DRGs, or Diagnosis Related Groups, categorize hospital cases for payment purposes under Medicare.
Electronic Processes
- EDI is Electronic Data Interchange, allowing for digital transactions between health care providers and insurers.
- EFT signifies Electronic Funds Transfer, the method for direct payment deposits from Medicare.
Regulatory and Reporting Standards
- FIPS are Federal Information Processing Standards guiding data management.
- FISS stands for Fiscal Intermediary Standard System, used for processing Medicare Part A claims.
- FVR is the Final Validation Report, verifying the accuracy of claims processed.
Health Care Eligibility and Resource Groups
- HETS represents the HIPAA Eligibility Transaction System, which checks eligibility for services.
- HHRG is the Home Health Resource Group used for reimbursement in home health care.
- HIPAA, the Health Insurance Portability and Accountability Act, protects patients' medical information.
Payment Models and Identifiers
- HIPPS stands for Health Insurance Prospective Payment System, impacting how payments are structured.
- ICD refers to the International Classification of Diseases, used for coding diagnoses.
- MA stands for Medicare Advantage, offering alternative coverage plans.
Facilities and Service Types
- LTCH means Long Term Care Hospital, catering to patients requiring extended care.
- IPF represents Inpatient Psychiatric Facility, providing specialized mental health services.
Quality Improvement Systems
- iQIES denotes Internet Quality Improvement and Evaluation System, enhancing care quality.
- OPPS stands for Outpatient Prospective Payment System, outlining payment for outpatient services.
Assessment and Follow-Up in Care
- PDGM is the Patient Driven Grouping Model, a new approach for home health payment based on patient characteristics.
- RFA refers to Reason for Assessment in patient care evaluations.
- RFA4 is Routine Follow-up OASIS Assessment, used in home health care.
Additional Medicare Components
- RA signifies Remittance Advice, detailing the payments made and adjustments.
- TOB means Type of Bill, a coding system for identifying the nature of a claim.
- RIC refers to Resources for Integrated Care, aimed at supporting coordinated services.
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Test your knowledge on key terms from Chapter 10 of the Medicare Benefit Policy Manual. This flashcard quiz covers essential definitions and concepts related to Medicare Administrative Contractors and other important terms. Perfect for anyone preparing for exams in healthcare administration.