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| If Congress does not react by October 15, the MVPS rate is established by using a __________. |
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Physician Payment Reform protects Medicare beneficiaries by:
a) setting a time line for when claims must be submitted
b) reducing claims that were submitted late
c) requiring participating physicians to accept amount paid as payment in full
d) instigating rules limiting how much non-participating physicians can charge
e) all of the above
f) all but c and d |
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Definition
| The Social Security Act requires physicians to submit claims within ___ months of the service date. There is a grace period of ___ months, but there will be a ___ reduction. |
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Term
| Maximum Actual Allowable Charge |
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Definition
| What does MAAC stand for? |
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Definition
| New limits enforced on non-participating physicians and suppliers that do not alow them to charge more than the limiting charge. |
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Definition
Limiting charge is specific to each physician.
a) This statement is false
b) This statement was true in 1991-1992, but no longer is
c) This statement is true
d) This statement is true for physicians within a locality |
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Term
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Definition
| T or F: Limiting charge for all physicians within a locality is the same, regardless of specialty. |
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| Advanced Beneficiary Notice |
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Definition
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| Electronic Remittance Advice |
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Definition
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| Standard Paper Remittance Advice |
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| What two formats will a provider receive transmissions in? |
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False
It applies to all of them |
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Definition
| T or F: The limiting charge applies to specific services listed in the Medicare Physicians' Fee Schedule that is performed by a nonparticipating physician, but not to all of them. |
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Definition
| T or F: Limiting charges apply even if a nonphysician provider provides the technical component of a service that is on the fee schedule |
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Definition
| T or F: When a adjustment of the full fee schedule amount is made to a service, the limiting charge must also be adjusted |
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Term
| site-of-service limitation |
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Definition
| rule that states that services that are performed primarily in office settings receive a payment discount if they are performed in an outpatient hospital department |
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Term
| Because hospitals also bill Medicare for the use of the room and supplies |
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Definition
| Why was the site-of-service limitation rule put into place? |
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Definition
If a surgeon performs more than one procedure on the same patient on the same day:
a) he receives full payment for each service
b) he gets a 10% reduction in payment
c) he receives discounts on subsequent procedures |
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Term
| 100; 50; 25; documentation; review |
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Definition
| A surgeon that performs more than one procedure on the same patient on the same day gets ____% of the fee for the highest value procedure, ____% for the second most expensive procedure, and ____% for the third, fourth, and fifth procedures. Each procedure after the fifth requires _______ and special _____ to determine the payment amount. |
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Term
| They pay the difference between the next highest endoscopy and the highst valued endoscopy |
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Definition
| With multiple endoscopic procedures performed on the same patient on the same day, Medicare allows full value of the highest valued endoscopy. How do they pay the second endoscopy? |
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Term
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Definition
| T or F: While many insurance carriers follow Medicare's reimbursement rules, some have their own policies |
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Term
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Definition
| Term, when used in reference to multiple surgical procedures performed at the same time, means that the general multiple-procedure reimbursement rules don't apply |
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Term
False
Medicare pays the same amount for the services, though it pays each physician their part of the service |
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Definition
| T or F: Under the fee schedule, Medicare pays different amounts for surgical services furnished by several physicians than it would pay for a physician that furnished all the services. |
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Definition
In the policy with reimbursement where there are multiple physicians furnishing surgical services, it is assumed that each physician always furnishes the usual and necessary:
a) preoperative care
b) intraoperative services
c) in-hospital postoperative services
d) all of the above
e) all but a |
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Definition
| The weighted percentages for total global surgical work is ___% for preoperative care, ___% for intraoperative service, and ___% for postoperative care. |
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Definition
| T or F: Physicians assisting the primary physician in a procedure receive a set percentage of the total fee for the service. |
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Definition
| T or F: When two surgeons of different specialties perform a procedure, each is paid an equal percentage of the global fee. |
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Term
False
No payment is made to assitant-at-surgery in this case |
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Definition
| T or F: An assistant-at-surgery is entitle to 16% of the total global fee if two co-surgeons perform the procedure |
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| For team surgry, a _______ determines the payment amounts on an individual basis. |
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