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Medicare & Medicaid

Question	Answer
Which of the following points is a guideline for the acute hospital prospective payment system?	Incentive for cost control because hospitals retain profits or suffer losses based on differences between payment rate and actual costs
What is the average of the sum of the relative weights of all patients treated during a specified time period?	Case mix index
Select the highest level of the IPPS hierarchy:	Major diagnostic category
What is the general term for software that assigns inpatient diagnosis related groups?	Grouper
What is Medicare's term for a facility with a high percentage of low-income patients?	Disproportionate share hospital
What condition does CMS require be met for a facility to receive the indirect medical education adjustment?	Medical residents in an approved graduate medical education program
What is the name of the entity that pays Medicare Part A claims?	Medicare Administrative Contractor
In MS-DRGs, for what is the case mix index a proxy?	Consumption of resources
In the IPPS, what is the term for each hospital's unique standardized amount based on its costs per Medicare discharge?	Base payment rate
What is the basis of the "labor-related share"?	Facilities' costs related to payrolls, benefits, and professional fees
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?	The first hospital receives a per-diem payment derived from the potential MS-DRG and the second hospital receives the full MS-DRG.
New medical technologies are often very expensive. What is the CMS' position on the use of new technologies to treat Medicare beneficiaries?	CMS encourages the use of new technologies through a regulatory process that formally identifies a status of "new technology" and, thereby, allows a payment for the full DRG plus 50 percent of the new technology's cost.
Which reimbursement scheme is used in the Inpatient Psychiatric Facility Prospective Payment System?	Per diem rate
Under the IPF PPS which states are included in the cost of living adjustment (COLA)?	Alaska and Hawaii
For purposes of Medicare reimbursement, which of the following situations represents a discharge from the first acute IPPS hospital and not a transfer?	The patient is discharged from one acute IPPS hospital and is admitted to a second acute IPPS hospital on the third day.
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?	Conversion Factor
What is the term for an index based on relative differences in the cost of a market basket of goods across areas?	GPCI
All of the following elements are used to calculate a Medicare payment under RBRVS EXCEPT:	Extent of the physical exam
Which one of the following statements characterizes the RBRVS payment system?	RBRVS payment system reflects the skill and resources required for each procedure.
Which of the following sites is considered a facility in the RBRVS payment system?	Ambulance
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?	Practice expenses
All of the following items are packaged under the Medicare Hospital Outpatient Prospective Payment System (HOPPS) EXCEPT for	medical visits
Which of the following statements is TRUE about APCs?	APCs are based on the CPT or HCPCS code(s) reported
In the APC system, an outlier payment is paid when which of the following occurs?	The cost of the service is greater than the APC payment by a fixed ratio and exceeds the APC payment plus a threshold amount
The HOPPS encompasses a variety of PPSs. All of the following are HOPPS system EXCEPT:	percent of billed charges
Under the Ambulance Fee Schedule, what is used to determine the level of service for ground transport?	EMS provider skill set used during the transport
What is the maximum number of APCs that may be assigned per encounter?	Unlimited
Under the HOPPS, outpatient services that are similar both clinically and in use of resources are assigned to separate groups called ___.	Ambulatory Payment Classifications
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.	hold harmless
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?	no payment is made to the ambulance supplier/provider
Which of the following staus indicates that the APC payment is reduced when multiple procedures with this status are reported together?	T- surgical service
Which of the following is NOT and adjustment provided under the Ambulance Fee Schedule?	Urban area service adjustment
Under the ASC List multiple procedure performed during the same surgical session are reimbursed at which of the following rate?	The procedure in the highest level group received full payment and the remaining receive half (50%) payment
The Medicare Modernization Act of 2003 mandated the creation of a new PPS for ASC services because:	There is disparity between ambulatory surgical center and hospital outpatient facility payments for the same services
Medicare-certified ASCs must accept assignment, meaning	an ASC must accept Medicare payment as payment in full
Under the SNF PPS, which one of the following healthcare services is excluded from the consolidated payment?	Radiation therapy
In the SNF PPS, which data set determines a resident's classification into a resource utilization group?	Minimum Data Set
Generally, what is the average length of stay of long-term care hospitals?	Greater than or equal to 25 days
In terms of grouping and reimbursement, how are the MS-LTC-DRGs and acute care MS-DRGs similar?	Based on principal diagnosis
In the LTCH PPS, what is the standard federal rate?	Constant that converts the MS-LTC-DRG weight into a payment
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?	Brain injury
All of the following elements are part of the IRF PPS EXCEPT:	Major diagnostic category
In the IRF PPS, what is the tool for data collection that drives payment?	Patient Assessment Instrument
What data set provides the underpinning of the HHPPS?	OASIS
All of the following services are consolidated into a single payment under the HHPPS EXCEPT:	Durable medical equipment
Which of the following elements is directly adjusted by the local wage index?	Labor portion
All of the following domains are part of the HHPPS case mix EXCEPT:	Medical malpractice
Which classification system is used to case-mix adjust the SNF payment rate?	Resource utilization groups
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?	Concurrent
In the PAC payment systems, which tool does CMS use to adjust its payment rates to account for geographic variations in costs?	Market basket
Patients with all of the following conditions are appropriate for LTCHs EXCEPT:	Acute myocardial infarction
According to CMS, what is one of the purposes of the IRF PPS?	To promote equity for beneficiaries, facilities, and taxpayers
For what variations in resource consumption does the HHPPS account?	Number of therapy visits by a therapist
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?	Skilled nursing facility
What is the term used in a rehabilitation facility to mean "a patient's ability to perform activities of daily living?"	functional status
All of the following elements are found in a charge description master, EXCEPT for:	DEG
Which of the following is the definition of revenue cycle management?	Coordination of all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue
The term "hard coding" refers to:	CPT codes that appear in the hospital's chargemaster
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?	Accounts receivable
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 ____?	Collected
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.	30-day
Most facilities begin counting days in accounts receivable at which of the following times?	The date the bill drops
The amount of money owed a healthcare facility when claims are pending is called ____:	Dollars in accounts receivable
The dollar amount the facility actually bills for the services it provides is known as:	Charge
The difference between what is charged and what is paid is known as:	Contractual allowance
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?	MSN
Which of the following is NOT a function area of the revenue cycle?	Volunteer services
Which entity is responsible for processing Part A claims and hospital-based Part B claims for institutional services on behalf of Medicare?	Medicare Administrative Contractor
Which of the following is NOT used to reconcile accounts in the patient accounting department?	Medicare Code Editor
In a typical acute care setting, Admitting is located in which revenue cycle area?	Pre-claims submission
In a typical acute care setting, Aging of Accounts reports are monitored in which revenue cycle area?	Accounts receivable
In a typical acute care setting, Charge Entry is located in which revenue cycle area?	Claims processing
In a typical acute care setting, Patient Education of Payment Policies is located in which revenue cycle area?	Pre-claims submission
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?	Claims reconciliation/collections
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?	Claims processing
What targets should be the focus of pay-for-performance or value-based purchasing systems?	Targets for which valid and reliable performance measures are available.
Which of the following situations would be included in a penalty-based model of pay-for-performance?	Compensation withheld for lack of improvement
Which of the following entities sponsor pay-for-performance systems?	All of the above
How do organizations control costs indirectly?	Reduce errors
Why are incremental implementations of pay-for-performance systems preferable to full-scale implementations?	Sponsors can evaluate policies and procedures.
In value-based purchasing and pay-for-performance systems, characteristics of adopted performance measures should include all the following EXCEPT:	Authoritarian
Which of the following incentives is non-financial?	Public report cards
Which piece of legislation initiated the Reporting of Hospital Quality Data for Annual Payment Update (RHQDAPU) program?	Medicare Modernization Act
The Tax Relief and Health Care Act of 2006 (MIEA-TEHCA) expanded CMS quality initiatives to which two setting?	Hospital outpatient departments and Ambulatory Surgical Centers
Which condition is not included on the Hospital Acquired Conditions provision list for FY 2009?	Staphylococcus infections

Created by: snuzyque

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