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Classification&Reimb
Classification& Reimbursement HIT exam
| Question | Answer |
|---|---|
| What does CPT stand for? | Current Procedural Terminology |
| What is a comprehensive, descriptive list of terms and numeric codes used for reporting diagnostic and therapeutic procedures and other medical services performed by physicians? | Current Procedural Terminology (CPT) |
| What is DSM-IV stand for? | Diagnostic and Statistical Manual of Mental Disorders, Fourth Revision. |
| What does DSM-IV mean? | The standard classification of mental disorders used by mental health professionals in the United States |
| What does HCPCS stand for? | Healthcare Common Procedure Coding System |
| What is Healthcare Common Procedure Coding System? | Healthcare Common Procedure Coding System. An alphanumerical classification system that identifies healthcare procedures, equipment, and suppliers for claim submission purposes. |
| What are the three levels of HCPCS? | I Current Procedural Terminology codes, developed by the AMA; II, codes for equipment, supplies, and services not covered by Current Procedural Terminology codes as well as modifiers that can be used with all levels of codes, developed by CMS |
| What does ICD-9-CM stand for? | International Classification of Diseases, Ninth Revision, Clinical Modification |
| What is ICD-9-CM? | A classification system used in the United States to report morbidity and mortality information |
| What are the four cooperative parties that maintain ICD-9-CM? | National Center for Health Statistics (NCHS), the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), and the Centers for Medicare and Medicaid Services (CMS) |
| what is ICD-O-3 stand for? | International Classification of Diseases for Oncology, Third Edition |
| What does International Classification of Diseases for Oncology, Third Edition do? | A system used for classifying incidences of malignant disease. |
| What does ICD-10-CM stand for? | International Classification of Diseases, 10th Revision, Clinical Modificaiton |
| What is ICD-10-CM? | The planned replacement for ICD-9-CM, vol. 1 and 2, developed to contain more codes and allow greater specificity. |
| What does SNOMED CT stand for? | Systematized Nomenclature of Medicine Clinical Terminology |
| What is SNOMED? | comprehensive clinical vocabulary developed by the College of American pathologists that is the most promising set of clinical terms available for a controlled vocabulary for healthcare |
| What is mortality? | A term referring to the incidence of death in a specific population. The loss of subjects during the course of a clinical research study. |
| What is morbidity? | A term referring to the state being diseased (including illness, injury, or deviation from normal health); the number of sick persons or cases of disease in relationship to a specific population |
| What does APC stand for? | Ambulatory Payment Classification |
| What is Ambulatory Payment Classification? | Hospital outpatient prospective payment system (HOPPS). The classification is a resource-based reimbursement system |
| What does DRG stand for? | Diagnosis Related Group |
| What is Diagnosis Related Group? | A unit of case-mix classification adopted by the federal government and some other payers as a prospective payment mechanism for hospital inpatients in which diseases are placed into groups because related diseases and treatments tend to consume similar a |
| What does OPPS stand for? | Outpatient Prospective Payment System |
| What is Outpatient Prospective Payment System | The Medicare prospective payment system used for hospital-based outpatient services and procedures that is predicated on the assignment of ambulatory payment classifications. |
| What does UCR stand for? | Usual, customary, reasonable |
| What does RUG stand for? | Resource Utilization Groups |
| What are Resource Utilization Groups? | A resident classification system based on the MDS resident assessments. |
| What does HHRG stand for? | Home Health Resource Group |
| What is Home Health Resource Group? | . A classification system with 80 home health episode rates established to support the prospective reimbursement of covered home care and rehabilitation services provided to Medicare beneficiaries during 60-day episodes of care |
| What is fee for service? | A method of reimbursement through which providers retrospectively receive payment based on either billed charges for services provided or on annually updated fee schedules |
| What is PPS stand for? | Prospective Payment System |
| What is Prospective Payment System? | . A type of reimbursement system that is based on preset payment levels rather than actual charges billed after the service has been provided |
| What is Retrospective payment system? | Type of fee-for-service reimbursement in which providers receive recompense after health services have been rendered |
| What does RAVEN stand for? | Resident Assessment Validation and Entry |
| What is RAVEN? | A type of data-entry software developed by the Centers for Medicare and Medicaid Services for long-term care facilities and used to collect Minimum Data Set assessments and to transmit data to state databases |
| What does HAVEN stand for? | Home Assessment Validation and Entry |
| What is HAVEN? | Home Assessment Validation and Entry. A type of data-entry software used to collect Outcome and Assessment Information Set (OASIS) data and then transmit them to state databases |
| What does HEDIS stand for? | Health Plan Employer Data and Information Set |
| What is HEDIS? | A set of performance measures developed by the National Commission for Quality Assurance that are designed to provide purchasers and consumers of healthcare with the information they need to compare the performance of managed care plans |
| What does OASIS stand for? | Outcomes and Assessment Information Set |
| What is OASIS? | A standard core assessment data tool developed to measure the outcomes of adult patients receiving home health services under the Medicare and Medicaid programs. |
| What is TRICARE? | The federal healthcare program that provides coverage for the dependents of armed forces personnel and for retirees receiving care outside military treatment facilities in which the federal government pays a percentage of the cost |
| What does CHAMPVA stand for? | Civilian Health and Medical Program-Veterans Affairs |
| What is CHAMPVA? | . The federal healthcare benefits program for dependents of veterans rated by the Veterans Administration as having a total and permanent disability, for survivors of veterans who died from VA-related service-connected conditions |
| what is medigap? | A private insurance policy that supplements Medicare coverage |
| what is medicare? | A federally funded health program established in 1965 to assist with the medical care costs of Americans 65yrs of age and older as well as other individuals entitled to Social Securtity benefits owing to their disabilities |
| what is medicaid? | An entitlement program that oversees medical assistance for individuals and families with low incomes and limited resources; jointly funded between state and federal governments |
| how do you calculate the case-mix index? | index you multiply the number of patients by the CMS relative weight. That gives the total CMS relative weight. Next you take the sum of the total CMS relative weight and divide it by the sum of the total of patients. |
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