Excersises in Chapter 1 – Flashcards
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Automatic coverage under Social Security
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Part A
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Optional coverage under Social Security
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Part B,C,D
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Hospice care coverage
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Part A
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Prescription drug coverage
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Part D
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Physician visit coverage
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Part B
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Beneficiary pays premium for coverage
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Part B,C,D
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The major third party payer in the US is the
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Government
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Hospital insurance is Medicare, Part
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B
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Supplement Medical Insurance is Medicare Part
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C
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Codes assigned for payment using diagnoses: CPT and HCPCS
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A,B,C
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What 4 parts of the HIPAA are a direct result of major changes to the HC industry?
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1. Electronic transactions and code set standard requirements 2. Privacy requirements 3. Security requirements 4. National Identifier requirements
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Which edition of the Federal Register is of special interest to hospital facilities?
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October
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Which edition of the Federal Register is of special interst to outpatients facilities?
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Nov & Dec
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What is the issuing office for the Federal Register?
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DHHS
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What is the service date the proposed changes are applicable?
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Jan
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According to the Summary section in Fig. 1-3, the amendment appeared in the November 28, 2011 edition of the
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Federal Register
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This organization develops a work plan to identify areas of the Medicare program that will be monitored.
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OBI = Office of Benefit Integrity
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The physician responsible for controlling and managing the health care of an HMO enrollee is the
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Gatekeeper
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Two insurane programs were established in 1965 by amendments to the Social Security Act known as Part __ and Part ___
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A,B
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The Secretary of DHHS has delegated responsibility for medicare to which department?
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CMS= Center of Medicare,Medicade Services
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Who administers funds for Medicare?
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Social Security
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Who is eligible for Medicare?
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Persons over the age of 65 and worked for 10years Persons with end stage renal disease A person that is disable
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List three components of the relative value unit:
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Work, Overhead, Malpractice
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Intentional deception or misrepresentation is known as
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Fraud
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QIO was previously termed
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Pro's
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MS-DRG assignment reports ____ services
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Part A Hospital
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October editions of the Federal Register are of special interest to
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Hospital facilities
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OBRA 1989 contained modifications and clarifications regarding the
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Physician Fee Schedule
