What are the three items that Medicare beneficiaries are responsible for paying before Medicare will begin to pay for services.
100
the gatekeeper
What is the individual who has been assigned by an HMO to monitor the services provided to the patient both inside the facility and outside the facility.
100
National Provider Identification (NPI)
What is the number that is assigned to all providers as a result of HIPAA.
100
clinical diagnosis
What is the International Classification of Disease 9th or 10th revision with Clinical Modification.
100
EMR
What is electronic medical record
200
CMS (Centers for Medicare and Medicaid Services)
What is the organization delegated by the Secretary of the Department of Health and Human Services to be responsible for administering the Medicare program.
200
Staff Model
What is the model of HMO that directly employs the physician
200
Health Insurance Portability and Accountability Act
What is the meaning of HIPAA
200
Medical Necessity
What is proven by assigning a code from the ICD code book.
200
CPT
What is current procedural terminology
300
Social Security Administration
What is the organization that handles the funds for the Medicare program.
300
Individual Practice Association
What is the model of HMO that contracts with the physician to provide the service at a set fee.
300
Administrative Simplification
What is the act as a result of HIPAA that was the result of the most major changes to the health care industry.
300
Report physician and other health services
What are the HCPCS and CPT code books
300
NDC
What is national drug classifications
400
a. persons eligible for disability benefits from Social Security
b. persons with permanent kidney failure requiring dialysis or transplant
What are the two groups of persons that were added to those eligible for Medicare benefits after the initial establishment of the Medicare program.
400
Group Practice Model
What is the HMO in which an organization of physicians contracts to provide services to the enrollees of the HMO.
400
PHI (Protected Health Information)
What is the HIPAA privacy requirement that governs the disclosure of patient information placed in the medical record by health care providers and ancillary medical staff.
400
medical supplies, orthotics and durable medical equipment
What is the HCPCS code book.
400
HIPAA
What is health insurance portability and accountability act
500
MACs or Medicare Administrative Contractors
What are the organizations that are contracted to do the paperwork for Medicare and are usually insurance companies that bid for the contract to handle the Medicare program for a specific geographic area.
500
Medicare Advantage
What is the HMO provided for Medicare beneficiaries rather than the traditional fee for service model that is used by Medicare.
500
(EDI) Electronic Data Interchange
What is the software that supports the electronic transmissions of medical claims and other transactions that must be compatible with the HIPAA transaction standard Version 5010.