Week 15

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Across
  1. 4. submit health insurance claims to insurance companies to receive payment for the services they provide to patients. Providers
  2. 5. Surgery MPFS Indicator 1 signifies a 150% adjustment for bilateral procedures, with 100% for one side and 50% for the second side. Bilateral
  3. 6. Medicare insurance that covers inpatient care in hospitals. PartA
  4. 8. generally have filing deadlines for claims, and for Medicare claims, they must be filed within 12 months from the date of service. Payers
  5. 10. A national provider identifier (NPI) is a unique 10-digit number used by HIPAA- covered health care providers. identifier
  6. 14. may be needed for services rendered to ensure that the service is approved in advance for coverage. Preauthorization
  7. 16. Medicare advantage insurance in which beneficiaries can choose a private payer's managed care type of insurance. Medicare pays the private health plan a capitated rate. PartC
  8. 18. medical coding can potentially impact a patient's future insurability or quality of health care. Inaccurate
  9. 20. Judicial Review in US District Court, and the request must be filed within 60 days of the Appeals Council's decision. Level5
  10. 23. must be submitted as soon as possible to avoid problems in processing benefits, as delays increase the chances of a problem occurring. Claims
  11. 25. Payment determined by several factors including the type of provider and the type of medical service, supply, or pharmaceutical provided.
  12. 26. Reconsideration by a Qualified Independent Contractor (QIC), ensuring independent review. Level2
Down
  1. 1. Hearing by an Administrative Law Judge (ALJ), and an appeal may be made within 60days of the reconsideration decision. Level3
  2. 2. Health insurance policy outlines what health care services and supplies the insurer what they will pay for in exchange for a payment of a premium.
  3. 3. schedule is a listing of allowable amounts payers agree to for paying claims. Fee Geographic Practice Cost Index that adjusts the nationally derived RVUs to account for geographic variations in costs. Geographic
  4. 4. A preauthorization may be needed for services rendered to ensure that the service is approved in advance for coverage. preauthorization
  5. 7. factor that is a national rate determined by Medicare at the beginning of each calendar year. Conversion
  6. 8. are billed directly even if they have no insurance. Patients
  7. 9. Medicare insurance coverage that covers prescription drugs. PartD
  8. 11. Medicare insurance coverage that covers physician or nonphysician providers' services and outpatient care in addition to other medical services that Part A doesn't cover. PartB
  9. 12. Common Procedure Coding System (HCPCS) Level II, a standardized coding system used primarily to identify products, supplies, and services not included in CPT codes.Healthcare
  10. 13. Security Act was established in 1965 as a federal health insurance program for individuals age 65 and older, regardless of income or health status. Social
  11. 15. The individual responsible for paying the charges is known as the______. guarantor
  12. 17. Review by a Medicare Appeals Council, and the request must be made within 60 days of the ALJ's decision. Level4
  13. 19. period defined as the number of days during which all necessary services normally furnished by a physician are included in the payment for the procedure performed. Global
  14. 21. Value Unit for an HCPCS code is determined by factors such as the physician's effort, practice expense, and malpractice component. Relative
  15. 22. Medicare Physician Fee Schedule funded by Part B is used to reimburse physician services and it is composed of resource costs associated with physician work, practice expense and professional liability insurance. reimburse
  16. 24. The billing of encounters involves coding and submitting claims to the insurance company. billing