- HCPCS “J codes” classify medications according togeneric or chemical name of drug, route of administration, and dosage.
generic or chemical name of drug, approval for Medicare coverage, and cost.
product name of drug, method of delivery, and cost.
product name of drug, route of administration, and dosage.
- The diagnosis that is the most significant condition for which procedures/services were provided is thefirst-listed diagnosis
- CPT Appendix A contains information aboutdeleted codes
new code descriptions
- Medicare administrative contractors must keep Medicare fees within a $20 million spending ceiling, as stated in the Balanced Billing Act (BBA). This is calledbalanced budget rule
the Medicare spending limit
- The document formerly known as the Explanation of Medicare Benefits is now known as theAdvance Beneficiary Notice
Medicare Payment Notice
Medicare Remittance Advice
Medicare Summary Notice
- The hospital assigns CPT codes to reportinpatient ancillary services
inpatient and outpatient surgery
inpatient surgical procedures
outpatient services and procedures
- The Medicare physician fee schedule amount for code 99213 is $100. The participating provider’s usual charge for this service is $125. Calculate the patient’s coinsurance amount.$20
- The unique identifier that CMS will assign to providers as part of the HIPAA requirements is called theGrp #
- Medicare is available to an individual who has worked at least5 years in Medicare-covered employment, is at least 65 years old, and is a permanent resident of the U.S.
10 years in Medicare-covered employment, is at least 62 years old, and is a citizen of the U.S.
10 years in Medicare-covered employment, is at least 65 years old, and is a citizen or permanent resident of the U.S.
25 years in Medicare-covered employment, is at least 62 years old, and is a citizen of the U.S.
- Which resources should be referenced when determining the potential for Medicare reimbursement?CPT coding manual
HCPCS coding manual
ICD-10-CM coding manual
Medicare Carriers Manual and Coverage Issues Manual