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Using Chapter 18 “Ambulatory Surgery Centers” See how many abbreviations and acronyms you can translate and then use this as a handy reference list. Definitions for the key abbreviations are located near the back of the Text-book in the glossary Copy and Paste your assignment on a separate MS word document or compatible file, and submit your completed assignment electronically via Moodle prior to the due date. Highlight your Answers Write “T” or “F” in the blank to indicate whether you think the statement is true or false. _______ 1. Health insurance payers have a variety of reimbursement plans and contracts with individual providers for payment. This means that the same type of service to two different patients may be paid differently depending on the type of contract or insurance that each patient has. _______ 2. A prospective payment system is a method of reimbursement in which Medicare payment is based on a predetermined fixed amount. _______ 3. An appeal must be filed within 6 months of a claim determination. _______ 4. Column 1/Column 2 edits are part of the NCCI. _______ 5. The electronic version of the CMS-1500 claim form is called the 837E. _______ 6. A free source of information about the number of global surgical days assigned to a code is the Medicare Fee Schedule Lookup Tool. _______ 7. The Administrative Simplification Compliance Act (ASCA) requires that claims be sent electronically to Medicare as a condition for payment. _______ 8. The Place of Service Codes Set is required for use in the implementation guide adopted as the national standard for electronic transmission of professional health care claims under the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). _______ 9. CMS will continue to look at ASC payment reform, specifically site neutrality and efficiency of care. _______ 10. Coverage and subsequent payment of a Medicare service depends on that service being medically necessary and medically reasonable. _______ 11. According to Medicare, ASCs are permitted to share space with Critical Access Hospital outpatient surgery departments and with Medicare participating Independent Diagnostic Testing Facilities (IDTF). _______ 12. The Medicare rules state that non-ASC facility services that are separately reimbursable include the physician’s professional services; sale, lease, or rental of durable medical equipment for ASC patients to use at home; services performed by an independent laboratory; and hospital-based ambulance services. _______ 13. Because an ASC bills to Part B of Medicare, the physician NCCI edits are the ones that apply. _______ 14. The NCCI contains one table of PTP edits for physicians/practitioners and one table of PTP edits for outpatient hospital services. _______ 15. All payers use the same modifiers.
SCIENCE
HEALTH SCIENCE
NURSING

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