Home Health & Hospice Week

Once you’ve answered the questions on page 164, compare your results against the answers below.

Answer 1. C. The acronym “MA” stands for Medicare Advantage, which is also known as Medicare Part C.

Answer 2: False. The CERT program and U.S. CERT are two completely unrelated things. First, U.S. CERT refers to the United States Computer Emergency Readiness Team and is partnered with the Cybersecurity & Infrastructure Security Agency. Both are under the Department of Homeland Security and often impact healthcare providers’ data security and patient safety, particularly with the rise in ransomware threats to healthcare.

The Centers for Medicare & Medicaid Services uses the Comprehensive Error Rate Testing (CERT) program to estimate improper payments and fix Medicare claims issues across its various programs.

Answer 3: False. HCPCS and HIPPS are coding systems, HIPAA is not. Healthcare Common Procedure Coding System (HCPCS) codes are produced by CMS and are standardized codes used for procedures, services, and supplies. HIPPS or Health Insurance Prospective Payment System codes are “rate codes [that] represent specific sets of patient characteristics (or case-mix groups) health insurers use to make payment determinations under several prospective payment systems,” CMS explains in guidance.

HIPAA, the Health Insurance Portability and Accountability Act of 1996, was a law enacted to set standards for health information and simplify the exchange of data, protect patients, and decrease fraud and abuse.

Answer 4: C. ADR can mean either depending on the source requesting the information. For example, you might receive an additional documentation request (ADR) from your Medicare Administrative Contractor (MAC) during a claims review or from Zone Program Integrity Contractors (ZPICs), Recovery Audit Contractors (RAC), Supplemental Medical Review Contractors (SMRCs), or a CERT contractor. The MACs sometimes refer to ADRs as additional development requests for the Targeted Probe and Educate (TPE) program.

And another rumor suggests that providers were confused, so some of the MACs started using “documentation” instead of “development” for the “D” in ADR — but essentially they mean the same thing in Medicare language.

Answer 5: False. Actually, NPI, NTP, and NPRM are all acronyms used frequently in the Medicare program.

National provider identifiers (NPIs) were mandated in 2004 under the NPI rule to align with HIPAA and simplify electronic transactions. They consist of a 10-digit numeric identifier and are specifically for HIPAA-covered healthcare providers.

NTP refers to the CMS National Training Program, which offers educational materials, training, and resources to providers and suppliers.

Notices of proposed rulemaking, or NPRMs for short, concern notifications about future federal healthcare rules and the Department of Health and Human Services and its affiliate agencies often mention them in releases, proposals, and final rules.

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