Principles Of Healthcare Reimbursement 9 & 10

Which of the following points is a guideline for the acute hospital prospective payment system?

What is the average of the sum of the relative weights of all patients treated during a specified time period?

Select the highest level of the IPPS hierarchy:

What is the general term for software that assigns inpatient diagnosis related groups?

What is Medicare's term for a facility with a high percentage of low-income patients?

What condition does CMS require be met for a facility to receive the indirect medical education adjustment?

What is the name of the entity that pays Medicare Part A claims?

In MS-DRGs, for what is the case mix index a proxy?

In the IPPS, what is the term for each hospital's unique standardized amount based on its costs per Medicare discharge?

What is the basis of the "labor-related share"?

A Medicare patient was discharged from one acute IPPS and admitted to another acute IPPS hospital on the same day. How will the two acute IPPS hospitals be reimbursed?

New medical technologies are often very expensive. What is the CMS' position on the use of new technologies to treat Medicare beneficiaries?

Which reimbursement scheme is used in the Inpatient Psychiatric Facility Prospective Payment System?

Under the IPF PPS which states are included in the cost of living adjustment (COLA)?

For purposes of Medicare reimbursement, which of the following situations represents a discharge from the first acute IPPS hospital and not a transfer?

The federal government is determined to lower the overall payments to physicians. To incur the least administrative work, which of the following elements of the physician payment system would the government reduce?

What is the term for an index based on relative differences in the cost of a market basket of goods across areas?

All of the following elements are used to calculate a Medicare payment under RBRVS EXCEPT:

Which one of the following statements characterizes the RBRVS payment system?

Which of the following sites is considered a facility in the RBRVS payment system?

Which element of the RVU accounts for the costs of the medical practice, such as office rent, wages of nonphysician personnel, and supplies and equipment?

All of the following items are packaged under the Medicare Hospital Outpatient Prospective Payment System (HOPPS) EXCEPT for

Which of the following statements is TRUE about APCs?

In the APC system, an outlier payment is paid when which of the following occurs?

The HOPPS encompasses a variety of PPSs. All of the following are HOPPS system EXCEPT:

Under the Ambulance Fee Schedule, what is used to determine the level of service for ground transport?

What is the maximum number of APCs that may be assigned per encounter?

Under the HOPPS, outpatient services that are similar both clinically and in use of resources are assigned to separate groups called ___.

These are financial protections that were created to ensure that certain types of facilities (i.e., cancer hospitals and small rural hospitals) recoup losses incurred due to payment differences between the HOPPS and pre-HOPPS (reasonable cost) payments.

When a patient is pronounced dead prior to an ambulance being called, which of the following payment provisions is followed under the Ambulance Fee Schedule?

Which of the following staus indicates that the APC payment is reduced when multiple procedures with this status are reported together?

Which of the following is NOT and adjustment provided under the Ambulance Fee Schedule?

Under the ASC List multiple procedure performed during the same surgical session are reimbursed at which of the following rate?

The Medicare Modernization Act of 2003 mandated the creation of a new PPS for ASC services because:

Medicare-certified ASCs must accept assignment, meaning

Under the SNF PPS, which one of the following healthcare services is excluded from the consolidated payment?

In the SNF PPS, which data set determines a resident's classification into a resource utilization group?

Generally, what is the average length of stay of long-term care hospitals?

In terms of grouping and reimbursement, how are the MS-LTC-DRGs and acute care MS-DRGs similar?

In the LTCH PPS, what is the standard federal rate?

To meet the definition of an IRF, facilities must have an inpatient population with at least a specified percentage of patients with certain conditions. Which of the following conditions is counted in the definition?

All of the following elements are part of the IRF PPS EXCEPT:

In the IRF PPS, what is the tool for data collection that drives payment?

What data set provides the underpinning of the HHPPS?

All of the following services are consolidated into a single payment under the HHPPS EXCEPT:

Which of the following elements is directly adjusted by the local wage index?

All of the following domains are part of the HHPPS case mix EXCEPT:

Which classification system is used to case-mix adjust the SNF payment rate?

The therapist in the skilled nursing facility is treating multiple patients who are each performing different therapies. How does CMS classify this mode of delivery?

In the PAC payment systems, which tool does CMS use to adjust its payment rates to account for geographic variations in costs?

Patients with all of the following conditions are appropriate for LTCHs EXCEPT:

According to CMS, what is one of the purposes of the IRF PPS?

For what variations in resource consumption does the HHPPS account?

In which of the PAC payment systems, is the adjusted rate multiplied by the patient's number of Medicare days to determine the reimbursement amount?

What is the term used in a rehabilitation facility to mean "a patient's ability to perform activities of daily living?"

All of the following elements are found in a charge description master, EXCEPT for:

Which of the following is the definition of revenue cycle management?

The term "hard coding" refers to:

In healthcare settings, the record of the cash the facility will receive for the services it has provided is known as which of the following terms?

Healthcare facilities should think of the collection process as part of the complete billing process and should educate staff to the fact that not all money billed is ____?

Aging of accounts is the practice of counting the days, generally in ____ increments, from the time a bill has been sent to the payer to the current day.

Most facilities begin counting days in accounts receivable at which of the following times?

The amount of money owed a healthcare facility when claims are pending is called ____:

The dollar amount the facility actually bills for the services it provides is known as:

The difference between what is charged and what is paid is known as:

What is the name of the notice sent after the provider files a claim that details amounts billed by the provider, amounts approved by Medicare, how much Medicare paid, and what the patient must pay?

Which of the following is NOT a function area of the revenue cycle?

Which entity is responsible for processing Part A claims and hospital-based Part B claims for institutional services on behalf of Medicare?

Which of the following is NOT used to reconcile accounts in the patient accounting department?

In a typical acute care setting, Admitting is located in which revenue cycle area?

In a typical acute care setting, Aging of Accounts reports are monitored in which revenue cycle area?

In a typical acute care setting, Charge Entry is located in which revenue cycle area?

In a typical acute care setting, Patient Education of Payment Policies is located in which revenue cycle area?

In a typical acute care setting, the Explanation of Benefits, Medicare Summary Notice, and Remittance Advice documents (provided by the payer) are monitored in which revenue cycle area?

In a typical acute care setting, which revenue cycle area uses an internal auditing system (scrubber) to ensure that error free claims (clean claims) are submitted to third party payers?

What targets should be the focus of pay-for-performance or value-based purchasing systems?

Which of the following situations would be included in a penalty-based model of pay-for-performance?

Which of the following entities sponsor pay-for-performance systems?

How do organizations control costs indirectly?

Why are incremental implementations of pay-for-performance systems preferable to full-scale implementations?

In value-based purchasing and pay-for-performance systems, characteristics of adopted performance measures should include all the following EXCEPT:

Which of the following incentives is non-financial?

Which piece of legislation initiated the Reporting of Hospital Quality Data for Annual Payment Update (RHQDAPU) program?

The Tax Relief and Health Care Act of 2006 (MIEA-TEHCA) expanded CMS quality initiatives to which two setting?

Which condition is not included on the Hospital Acquired Conditions provision list for FY 2009?