Question

CCI



GPCI



MPFS



UCR



RVS



RBRVS



MUE



RAC

Answer 1

A. CCI: Correct Coding Initiative—Medicare’s national program that applies computerized edits to claims to ensure compliant billing

B. GPCI: geographic practice cost index—a factor that Medicare uses to adjust fees according to for services provided in a particular geographic area

C. MPFS: Medicare Physician Fee Schedule—list of the allowed fees that are reimbursable to Medicare-participating physicians, based on the RBRVS system

D. UCR: usual, customary, and reasonable—charge-based payment system

E. RVS: relative value scale—system of assigning unit values to medical services based on an analysis of the skill and time required of the physician to perform them

F. RBRVS: resource-based relative value scale—federally mandated relative value scale for establishing Medicare charges

G. MUE: medically unlikely edit—a CMS unit-of-service edit that checks for clerical or software-based coding or billing errors, such as anatomically related mistakes

H. RAC: Recovery Audit Contractor (RAC)—a program designed to audit Medicare claims