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MA 1032 Medical Coding study notes

by: Megan

MA 1032 Medical Coding study notes MA 1032

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About this Document

Covers concepts for midterm
Medical Coding
Judy Kronenberger
Study Guide
medical, coding
50 ?




Popular in Medical Coding

Popular in Medical Assisting

This 4 page Study Guide was uploaded by Megan on Thursday March 24, 2016. The Study Guide belongs to MA 1032 at University of Cincinnati taught by Judy Kronenberger in Fall 2016. Since its upload, it has received 29 views. For similar materials see Medical Coding in Medical Assisting at University of Cincinnati.


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Date Created: 03/24/16
      MA 1032  OF  M EDICAL   B ILLING Chapter 1 study notes Medicare pays 80%; Beneficiary  pays 20% as well as deductible,  premiums, coinsurance, & 100%  MA 1032 of Medical  of non­covered services. Billing Chapter 1 study notes  AOA – Administration on Aging ACL – Administration for Community Living NHE – National Health Expenditure DHHS – Department of Health and Human Services Who is eligible to enroll in Medicare: People ages 65 and over + those with disabilities CMS – Centers for Medicare and Medicaid Services MAC – Medicare Administrative Contractors DME – Durable Medical Equipment Medicare Part A:  Hospital Insurance (covers rooms, meals, treatments, therapy) Medicare Part B:  Supplementary Insurance (not automatically provided to beneficiaries  when they are eligible; pays for medically necessary services, outpatient hospital services,  and home health care; beneficiaries pay premium each month. Medicare Part C: Medicare Advantage Organization (set of health care options from which  beneficiaries can choose their health care providers – HMO, PPO...) Medicare Part D: Prescription Drugs (Beneficiaries pay premium each month) HIPPA – Health Insurance Portability and Accountability Act of 1996.  Governs health care  portability, privacy, medical savings accounts, and long­term care insurance. EDI – Electronic Data Interchange. PHI – Protected Health Information.  All PHI is included in privacy requirements. NPI – National Provider ID. 1  Federal Register – Official publication for all “Presidential Documents”, “Rules &  Regulations,” “Proposed Rules,” & “Notices.” ( – Hospitals look into  October editions; Outpatient facilities look into Nov/Dec editions. RBRVS – Resource­Based Relative Value Scale: Decreases Medicare expenditures,  redistribute physicians’ payments more equitably, ensure quality health care at a reasonable rate. QIO Providers –  1. Direct payment is made to provider 2. 5% higher fee schedule than for non­QIO providers 3. Faster claim processing 4. Provider’s name listed in QIO directory Non QIO Providers –  1. Payments goes to patient on all claims 2. 5% lower fee schedule than that for QIO providers 3. Slower processing of claims MS­DRG – Medical Severity­Diagnosis Related Groups. MAAC – Maximum Allowable Charge that limits total amount non­QIO providers can  charge. RVU – Relative Value Unit (Work, Overhead, Malpractice) Standing Approval – Assigns benefits to the provider and is kept on file in the medical  office. OBI – Office of Benefits Integrity:  Oversees Medicare’s payment safeguard program related  to fraud, audit, and medical review. OIG – Office of Inspector General:  Develops annual work plan to outline the ways the  Medicare program is monitored to catch fraud. IOM – Internet Only Manual: Establishes regulations to follow to avoid fraud. Fraud –  1. Billing for services not provided. 2. Applying for duplicate payment. 3. Unbundling/exploding charges 4. Using another person’s Medicare card to obtain care. MCO – Managed Care Organization: Responsible for health care services offered to an  enrolled group or person. 2  PPO – Preferred Provider Organization: group of providers who form a network and have  agreed to provide services to enrollees at a discounted rate. HMO – Delivery System that allows enrollee access to all health care services.  Enrollee is  assigned a primary care physician who acts as Gatekeeper. IPA – Individual Practice Association: physician provides services for a set fee. EPO – Exclusive Provider Organization: providers of services are not prepaid. GPM – Group Practice Model: physicians make contracts with the HMO to provide services  to enrollees of HMO. PACE – Program for All­Inclusive Care for the elderly. 3 


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