Ambulatory Payment Classification for Medicare US Flashcards

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Front Back
A prospective hospital claims reimbursement system currently utilized by the fed gov
All Patient Diagnosis Related Groups Assignment of Benefits (APDRG)
A system of averagaing and bundling using CPT, HCPCS, and revenue codes submitted for payment.
Ambulatory Payment Classification (APC)
The maxium dollar amount set by a MCO that limits the total amount the plan must pay for all health care services provided to a subscriber in a year.
Annual Maximum Benefit Amount Deductible
Written authorization from the policy holder for their insurance company to pay benefits directly to the care provider.
Assignment of Benefits
A health insurance pla in which patients may selet any doctor or hospital and providers bill the patient or the insurance company their normal fees for their services.
Indemnity
Independent, not-for-profit organization and the nation's oldest and largest standards setting and healthcare accrediting body.
JCAHO (Joint Commission)
The maximum amount of benefit paid by the insurance company per isured. Once this lifetime maximum has been exhaused, the insruance compnay will not pay any benefits.
Lifetime Maximum
Medicare Part A coverage that entitles the beneficary to sixy days of inpatient coverage beyond the coinsurance day benefit period.
Lieftime Reserve Days (LRD)
An Association of the insurance commissioners of the states and territories.
National Association of Insurance Commissioners (NAIC)
Established uniform standards for billing with CPT and HCPCS codes.
National Correct Coding Initiative (NAIC)
A federal law which mandates that coverage for hospital stays for childbirth generally cannot be less than 48 hours for normal deliveries or 96 hours for cesarean births
Newborns' and Mothers' Health Protection Act (NMHPA)
The Office of the Inspector General, Department of Health and Human Services
Office of the Inspector General (OIG)
Many fedreal regulations that impact healthcare financing are the result of budget legislation.
Omnibus Budget Reconciliation Act (OBRA)
Active total care of patients who have advanced illnesses no longer amenable to curative treatment. Control of symptoms
Palliative Care
Negotiated daily payment for delivery of hospital services provided ( room and board)
Per Diem