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Side ASide B
What is the name of the federal health insurance program ?
Fiscal Intermediaries handles what?
handles claims from hospitals and other facilities; NF's..LTCF's..home health agencies
What part of Medicare covers hospice care?
Part A is run by?
CMS- Centers for Medicare and Medicaid Services
What is a crossover claim?
Medicare transmits a Medigap claim electronically to the Medigap carrier
Level II codes are also called what:?
HCPCS- national alphanumeric codes
Who can act on a Medicare beneficiary's behalf?
CAPS- Claim assistant professionals
What % does Medicare pay on?
80% of approved charges
Under what system are hospitals reimbursed according to preestablished rates for each type of diagnosis?
PPS- Prospective payment systems
What's it called when a Medicare beneficiary also has insurance through their employer?
Medicare Secondary Payer-MSP
What is the process when a RA is received by MCR (Medicae)?
post the patients name and the amount of the payment on the day sheet and the patients ledger
What part covers diagnostic test?
What process reviews claims for medical necessity and monitors numbers of times procedures can be billed?
Medicare Prepayment Screen
What is an explanation of Medicare Benefits referred as?
Medicare remittance advice document
Medicare payments to hospitals are based on what type of codes?
When a patient signs an ABN , what modifier must be added to the procedure code?
What are the functions of the digestive system ?
Digestion , Absorption , Elimination
What is the largest grandular organ in the body?
What are the teeth with sharp cutting edges called?
What is the part of the tooth seen above the gum line called?
What is the first portion of the small intestine called?