Key Terms
Key Terms
Key Terms
Billing Tips
Popuri
100
Used to identify the type of routine hospital bed, room accommodation, and board charge.
What are accomodation revenue codes?
100
The component subcategories of a four-digit code that are described using the convetion of an X in the last position.
What is a revenue code series?
100
Identifies services, other than routine room and board charges, that are incidental to the hospital stay.
What are ancillary service revenue codes?
100
Most health plans do not cover these except when medically necessary.
What are private rooms?
100
Supplies, Drugs, and ESRD services included in the composite rate.
What are the only Medicare outpatient services that do not require HCPCS codes?
200
Physician-ordered care provided to a patient admitted to evaluate a condition or determine a course of treatment.
What are observation services?
200
No dollars are to be reported in the amount field for these.
What are zero-billed revenue codes?
200
An X holds their place until it is replaced by a number from 0-9.
What is a subcategory code?
200
This code must be used when billing for drugs on an inpatient claim.
What is revenue code 025X (Pharmacy)?
200
Reports the quantitative measure of services rendered as specified by a given revenue code category.
What is the service units field (FL 46)?
300
A fixed amount charged on a daily basis during a patient's hospitalization or a total rate charged for an entire stay.
What is an all-inclusive rate?
300
Body parts or devices that are implanted in the body, including any object or material that is inserted or grafted into the body for prosthetic purposes, therapeutic purposes, or diagnostic purposes.
What are implantables?
300
Their purposes is to supplement the standard APC rate when the cost of a specific drug, biological, or device was not included in the base APC rate.
What are transition pass-through payments?
300
Except for orthotics and prosthetic devices and durable medical equipment that is implanted, outpatient DME is billed to Medicare on this.
What is a CMS-1500 claim form?
300
Terminology for Oxygen Charges - This is used to report both the equipment and the oxygen for a stationary system.
What is subcategory code 1?
400
Formerly known as lithotripsy.
What is ESWT (Extracorporeal Shock Wave Therapy)?
400
The process of removing excess fluid from the blood of dialysis patients by using a dialysis machine but without the dialysate solution.
What is ultrafiltration?
400
The record of the electrical currents associated with muscular activity.
What is an EMG (Electomyelogram or electromyogram)?
400
This is paid at a higher rate than a screening mammography.
What is a diagnostic mammography?
400
Pharmacy, Anesthesia, and Medical/Surgical supplies.
What are the three revenue codes referred to as "incident-to" charges?
500
Regional contracted carriers that process Medicare claims for durable medical equipment, prosthetics, orthotics, and supplies.
What are DMERCs (Durable Medical Equipment Regional Carriers)?
500
Under the provisions of this, a hospital that receives Medicare benefits must provide an appropriate medical screening examination and stabilizing treatment to any individual with an emergency medical condition and to any woman in active labor, regardless of the individual's ability to pay.
What is EMTALA (Emergency Medical Treatment and Active Labor Act)?
500
A five-digit alphanumeric payment code that represents specific sets of patient characteristics, or case-mix groups.
What is a HIPPS (Health Insurance Prospective Payment System) rate code?
500
GN, GO, and GP
What are the modifiers used with outpatient therapy services on Medicare claims?
500
Indicates the degree of nursing intervention required is complex care.
What is Subacute care Level III (0193)?
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