Medicare Benefit Policy Manual Chapter 10

Questions and Answers

What does A/B MACs (HHH) stand for?

Medicare Administrative Contractors (correct)

Medicare Assistance Bureau

Alternate Billing Medicare Associations

None of the above

What does A/B MAC (A) process?

Hospital claims (correct)

Outpatient claims

Home health claims

All of the above

What does ABN stand for?

Advanced Beneficiary Notice of Non-Coverage

What is the meaning of CBSA?

Core Based Statistical Area Signup and view all the answers

What is CCN in Medicare terminology?

CMS Certification Number Signup and view all the answers

What does CLIA stand for?

Clinical Laboratory Improvement Amendments Signup and view all the answers

What is COP in a healthcare context?

Conditions of Participation Signup and view all the answers

What does CWF stand for?

Common Working File Signup and view all the answers

What does DCN mean?

Document Control Number Signup and view all the answers

What is DDE in medical billing?

Direct Data Entry Signup and view all the answers

What does DMEPOS represent?

Durable Medical Equipment Prosthetics/Orthotics and Supplies Signup and view all the answers

What is dNWPT?

Disposable Negative Pressure Wound Therapy Signup and view all the answers

What does DOEBA stand for?

Date of Earliest Billing Activity Signup and view all the answers

What is DOLBA?

Date of Latest Billing Activity Signup and view all the answers

What do DRGs refer to?

Diagnosis Related Groups Signup and view all the answers

What does EDI stand for?

Electronic Data Interchange Signup and view all the answers

What does EFT represent?

Electronic Funds Transfer Signup and view all the answers

What are FIPS?

Federal Information Processing Standards Signup and view all the answers

What does FISS stand for?

Fiscal Intermediary Standard System Signup and view all the answers

What does FVR stand for?

Final Validation Report Signup and view all the answers

What is HETS?

HIPAA Eligibility Transaction System Signup and view all the answers

What does HHEH stand for?

Home Health Benefit Period Auxiliary File Signup and view all the answers

What is HHRG?

Home Health Resource Group Signup and view all the answers

What does HIPAA stand for?

Health Insurance Portability and Accountability Act Signup and view all the answers

What is HIPPS?

Health Insurance Prospective Payment System Signup and view all the answers

What does ICD stand for?

International Classification of Diseases Signup and view all the answers

What is IPF?

Inpatient Psychiatric Facility Signup and view all the answers

What does iQIES stand for?

Internet Quality Improvement and Evaluation System Signup and view all the answers

What does LTCH stand for?

Long Term Care Hospital Signup and view all the answers

What is MA in healthcare?

Medicare Advantage Signup and view all the answers

What does MBI stand for?

Medicare Beneficiary Identifier Signup and view all the answers

What is MTF?

Medicare Trust Fund Signup and view all the answers

What does NOA stand for?

Notice of Admission Signup and view all the answers

What is NUBC?

National Uniform Billing Committee Signup and view all the answers

What does OPPS stand for?

Outpatient Prospective Payment System Signup and view all the answers

What is PDGM?

Patient Driven Grouping Model Signup and view all the answers

What does PPS stand for?

Prospective Payment Systems Signup and view all the answers

What is RA in healthcare?

Remittance Advice Signup and view all the answers

What does RFA stand for?

Reason for Assessment Signup and view all the answers

What does RFA4 represent?

Routine Follow-up OASIS Assessment Signup and view all the answers

What is RIC in healthcare?

Resources for Integrated Care Signup and view all the answers

What does TOB stand for?

Type of Bill Signup and view all the answers

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.