Medicare Medical Billing Chapter 12
29 Questions
100 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the definition of 'benefit period'?

  • Time during which medical benefits are available to an insurance beneficiary (correct)
  • Period in which a health insurance premium is paid
  • Duration of a personal injury claim
  • Time taken for a health insurance application to be approved

    • What does COBRA stand for?

  • Cooperative Outpatient Benefit Relief Act
  • Comprehensive Outpatient Budget Reimbursement Act
  • Consolidated Outpatient Benefit Rights Act
  • Consolidated Omnibus Budget Reconciliation Act (correct)

    • What does 'crossover' refer to in Medicare?

    Reassignment of gaps in coverage that eliminates the need for a beneficiary to file a separate claim with his or her Medigap insurer.

    What does ESRD stand for?

    <p>End-stage renal disease</p> Signup and view all the answers

    What is an Electronic Remittance Advice (ERA)?

    <p>A document used to communicate payment information between Medicare and providers.</p> Signup and view all the answers

    What does HCPCS stand for?

    <p>Healthcare Common Procedure Coding System</p> Signup and view all the answers

    What are Local Coverage Determinations (LCDs)?

    <p>Updates sent to physicians regarding coding and medical information.</p> Signup and view all the answers

    What are Medicare intermediaries?

    <p>Private companies that have contracts with Medicare to pay Part A and some Part B bills.</p> Signup and view all the answers

    How is the limiting charge calculated?

    <p>It is 115% more than the nonparticipating provider's Medicare fee schedule.</p> Signup and view all the answers

    What constitutes Medicare abuse?

    <p>Improper payments for items or services without a legal entitlement.</p> Signup and view all the answers

    What is Medicare Advantage also known as?

    <p>Medicare+Choice</p> Signup and view all the answers

    What does MAC stand for?

    <p>Medicare Administrative Contractor</p> Signup and view all the answers

    What is a Medicare Development Letter?

    <p>A letter sent to a provider by Medicare requesting additional information to process a claim.</p> Signup and view all the answers

    What is Medicare Fraud?

    <p>Providing false information to claim medical reimbursements.</p> Signup and view all the answers

    What is Medicare Part A?

    <p>Hospital insurance</p> Signup and view all the answers

    What is Medicare Part B?

    <p>Medical insurance</p> Signup and view all the answers

    What is Medicare Part C?

    <p>Managed care health plans offered under the Medicare Advantage program.</p> Signup and view all the answers

    What does Medicare Part D cover?

    <p>Drug coverage</p> Signup and view all the answers

    What is a Medicare Remittance Notice (MRN)?

    <p>A remittance advice from Medicare to providers explaining how payments for claims were determined.</p> Signup and view all the answers

    What does MSP stand for?

    <p>Medicare Secondary Payer</p> Signup and view all the answers

    What is a Medicare Summary Notice (MSN)?

    <p>A summary sent to the patient from Medicare that outlines all services provided.</p> Signup and view all the answers

    What is Medigap?

    <p>A privately offered, Medicare-supplemental health insurance policy.</p> Signup and view all the answers

    What is the Non-PAR MFS?

    <p>Non-PAR MFS Amount that applies to unassigned services at a lower rate.</p> Signup and view all the answers

    What does OIG stand for?

    <p>Office of Inspector General</p> Signup and view all the answers

    What does PACE stand for?

    <p>Program of All-Inclusive Care for the Elderly</p> Signup and view all the answers

    What does RAC stand for?

    <p>Recovery Audit Contractor program</p> Signup and view all the answers

    What is scrubbing in medical billing?

    <p>The process of correcting claims that are incorrect to find and fix errors.</p> Signup and view all the answers

    What does TRHCA stand for?

    <p>Tax Relief and Health Care Act of 2006</p> Signup and view all the answers

    What is telemedicine in relation to Medicare?

    <p>Limited coverage for telemedicine services including audio and video telecommunications.</p> Signup and view all the answers

    Study Notes

    Medicare Medical Billing Key Terms

    • Benefit Period: Duration during which an insurance beneficiary can access medical benefits.

    • COBRA: Consolidated Omnibus Budget Reconciliation Act; allows terminated employees or those losing insurance due to reduced work hours to purchase group insurance for a limited time.

    • Crossover: Process to reassign coverage gaps, eliminating the need for separate claims with Medigap insurers; typically requires a signed release-of-information.

    • ESRD: End-stage renal disease; Medicare acts as a secondary payer for individuals with employer-sponsored coverage.

    • ERA: Electronic Remittance Advice; digital summary of payments to providers.

    • HCPCS: Healthcare Common Procedure Coding System; used for coding outpatient services and supplies for Medicare patients.

    • LCDs: Local Coverage Determinations; communications sent to physicians for updates on coding and medical information.

    • Intermediaries: Private companies contracted with Medicare to process Part A and certain Part B bills.

    • Limiting Charge: 115% over the nonparticipating provider's Medicare fee schedule; maximum amount a non-participating provider can charge an individual.

    • Medicare Abuse: Involves improper payments for services not legally entitled to reimbursement.

    • Medicare Advantage: Also known as Medicare+Choice; abbreviated as MA, it includes managed care health plans for beneficiaries.

    • MAC: Medicare Administrative Contractor; oversees claims processing and administration.

    • Medicare Development Letter: Official request from Medicare for additional information needed to process claims.

    • Medicare Fraud: Involves submitting false claims to receive reimbursement beyond actual services rendered.

    • Medicare Part A: Provides hospital insurance coverage.

    • Medicare Part B: Covers medical insurance services.

    • Medicare Part C: Managed care plans available to Medicare beneficiaries under the Medicare Advantage program.

    • Medicare Part D: Offers coverage for prescription drugs.

    • Medicare Remittance Notice (MRN): Detailed summary explaining how Medicare payments for claims were determined.

    • MSP: Medicare Secondary Payer; legislation that transfers payment responsibility from Medicare to other sources; vital for coordinating beneficiary benefits.

    • Medicare Summary Notice (MSN): Summary document sent to patients detailing services provided and benefits covered over a specific period.

    • Medigap: Private supplemental health insurance designed to cover costs not covered by Medicare.

    • Non par MFS: Non-participating Medicare Fee Schedule; applies to unassigned services by non-participating physicians, who may charge up to 115% of the nonparticipating fee.

    • OIG: Office of Inspector General; responsible for monitoring compliance with health care reimbursement laws.

    • PACE: Program of All-Inclusive Care for the Elderly; comprehensive care support for seniors.

    • RAC: Recovery Audit Contractor program; established to identify improper Medicare payments.

    • Scrubbing: Process of reviewing and correcting errors in claims submissions before processing.

    • TRHCA: Tax Relief and Health Care Act of 2006; legislation impacting health care provisions.

    • Telemedicine: Limited Medicare coverage for telehealth services involving audio and video communications.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Description

    Test your knowledge on Medicare medical billing concepts with these flashcards. This quiz covers key terms and their definitions to help you understand the intricacies of medical benefits and laws related to insurance coverage. Perfect for students or professionals in the healthcare field.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser