IVR = Interactive Voice Response (IVR) System Part A Interactive Voice Response (IVR) System ■1-866-497-7857 •Claim Status •Beneficiary Eligibility •Check status •General information regarding the Medicare Program

MSP = Medicare Secondary Payer   Applies when Medicare is not the beneficiary’s primary insurance   ■More than $4.5 billion saved annually on claims paid by primary insurers Job-related illness or injury covered under Worker’s Compensation ■Accident injuries covered under no-fault and/or liability insurance ■Federal Black Lung Program ■Veteran’s Benefits program for service-related conditions ■Public […]

RTP = Return to Provider

ERA = Electronic Remittance Advice (ERA) ERA transactions are sent based on the NPI/PTAN combination when the payee information is different than the rendering data •The zip codes entered on the claims are used to match to the appropriate PTAN ■Reports the final claim(s) information •Covered charges •Non covered charges •Coinsurance Reports the adjustment to […]

EFT = Electronic Funds Transfer   Benefits of EFTs   ■Funds are available faster   ■Administrative costs are reduced   ■Accounting Department can reconcile receivables   ■Contribute to the Paper Reduction Act    

  EDI= Electronic Data Interchange   EDI helps provide quick efficient exchange of healthcare information   •EDI provides access to HIPAA compliant transactions   ■270/271 Eligibility Response in real time from the CMS data center   ■276/277 Claims Status Inquiry within one day from EDI    

Medicare Acronyms searchable list Rural Health Clinics (RHC) Federally Qualified Health Clinics (FQHC) End Stage Renal Dialysis (ESRD) Fee-For-Service (FFS) Medicare benefits •QIO –Quality Improvement Organizations •COBC –Coordination of Benefits Contractor •QIC –Qualified Independent Contractor •WIC –Western Integrity Center •CERT –Comprehensive Error Rate Testing Contractor •RAC –Recovery Audit Contractor

MSN= Medicare Summary Notice (MSN) http://www.medicare.gov/navigation/medicare-basics/understanding-claims/understanding-claims-overview.aspx If you get a Medicare-covered service, you’ll  get a Medicare Summary Notice (MSN) in the mail every 3 months. The notice shows  all your services or supplies that providers and suppliers billed to Medicare  during the 3-month period, what Medicare paid, and what you may owe the  provider. This […]

MPPR=Multiple Procedure Payment reduction. 100% of most expensive procedure, and other similar procedures reduces by a certain percentage if done by same physician on same date http://cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM7442.pdf