CPC Exam Review Chapter 1 Prep. 100% Comprehensive. Rated A+

CPC Exam Review Chapter 1 Prep. 100% Comprehensive. Rated A+ CMS - -Center for Medicare & Medicaid Services Medicare - -coverage individuals over 65 years old, blind, disable and individuals with permanent kidney disease and end stage renal disease (ESRD) ESRD - -end stage renal disease CMS regulations - -determine the coding requirements for medicare and non-medicare payers alike. Medicare part A - -Cover impatient hospital care, nursing facilities, hospice care and home healthcare. Medicare part B - -Cover medically necessary physician's services, outpatient care and other medical services, including some preventive services. Is an optional service that require a premium payment and a yearly deductible and co insurance. Medicare part C - -Is know as Medicare Advantage, that combines Part A and part B. Is manage by a private insurer approve by Medicare. Medicare part D - -Is a prescription drug coverage program available to all Medicare beneficiaries. Private companies approved by Medicare provide coverage. Medicaid - -Is a health insurance assistance program for low income people. Medicare payments - -The Medicare payments for physicians services are standardized using a resource-base relative value scale (RBRVS) RBRVS - -Resource-base relative value scale The resource cost is divide by 3 components: - -Physician work, practice expense and professional liability insurance. Physician work - -52 % of the relative value Practice expence - -44% of the relative value. Is a resource-base relative value and differ by site of services. (can be different, depending the site of service; hospital or office.) Professional liability insurance - -4% of the relative value. PFS - -Physician Fee Schedule Medical necessity - -a procedure or service that is considered appropriate in a given circumstances. The National Coverage Determination (NDC) - -explain when Medicare will pay for items and services. If a NDC doesn't exit for a particular item, it's up to the MAC to determinate