Across
- 4. submit health insurance claims to insurance companies to receive payment for the services they provide to patients. Providers
- 5. Surgery MPFS Indicator 1 signifies a 150% adjustment for bilateral procedures, with 100% for one side and 50% for the second side. Bilateral
- 6. Medicare insurance that covers inpatient care in hospitals. PartA
- 8. generally have filing deadlines for claims, and for Medicare claims, they must be filed within 12 months from the date of service. Payers
- 10. A national provider identifier (NPI) is a unique 10-digit number used by HIPAA- covered health care providers. identifier
- 14. may be needed for services rendered to ensure that the service is approved in advance for coverage. Preauthorization
- 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
- 18. medical coding can potentially impact a patient's future insurability or quality of health care. Inaccurate
- 20. Judicial Review in US District Court, and the request must be filed within 60 days of the Appeals Council's decision. Level5
- 23. must be submitted as soon as possible to avoid problems in processing benefits, as delays increase the chances of a problem occurring. Claims
- 25. Payment determined by several factors including the type of provider and the type of medical service, supply, or pharmaceutical provided.
- 26. Reconsideration by a Qualified Independent Contractor (QIC), ensuring independent review. Level2
Down
- 1. Hearing by an Administrative Law Judge (ALJ), and an appeal may be made within 60days of the reconsideration decision. Level3
- 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. 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. A preauthorization may be needed for services rendered to ensure that the service is approved in advance for coverage. preauthorization
- 7. factor that is a national rate determined by Medicare at the beginning of each calendar year. Conversion
- 8. are billed directly even if they have no insurance. Patients
- 9. Medicare insurance coverage that covers prescription drugs. PartD
- 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
- 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
- 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
- 15. The individual responsible for paying the charges is known as the______. guarantor
- 17. Review by a Medicare Appeals Council, and the request must be made within 60 days of the ALJ's decision. Level4
- 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
- 21. Value Unit for an HCPCS code is determined by factors such as the physician's effort, practice expense, and malpractice component. Relative
- 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
- 24. The billing of encounters involves coding and submitting claims to the insurance company. billing