# BAS - Payment, PPS, DRG, Computer
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| PPS | Prospective Payment System. Used to calculate payments for Medicare, Medicaid
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| DRG | Diagnostic Related Group. Used to pay hospital admissions based upon a single diagnosis (organ)
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| RBRVS | Resource based Relative Value Scale. Used to pay doctors, clinics and hospitals based upon resources required to provide treatment
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| RVS | Relative Value Scale. A range of values for procedure payments. Each procedure has a relative weight and payment amount.
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| Calculating the RVS | This is based upon the relative weight and payment amount.
A relative weight of .5 and dollar amount of $100 would be calculated as: .5 x 100.00 = 50.00
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| LAN | Local area network. A network that is internal to a hospital, clinic, medical center, etc.
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| EHR, EMR | Electronic Health Record, Electronic Medical Record. A computerized collection of personal and medical information of patients. This system also includes the ability to interact with patients and providers via the internet.
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| Capitation | A payment method where the doctor is paid a single dollar amount based upon the population of patients in an insurance plan.
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| Fee-For-Service | A payment method in which the doctor is paid per procedure.
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| Factors considered in DRG payments | Secondary diagnosis, patient age, complications (present or not), comorbidities
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| comorbidity | a co-existing disease. Secondary disease. Secondary diagnosis. For example, Gangrene due to Diabetes.
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| APC | Ambulatory Payment Classification. A service classification system for outpatient encounters. This can be paid to a hospital only if it is for OUTPATIENT encounters. You have page 5 of this type of list.
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| RUGs | Resource Utilization Groups. Payment system. A payment system used for SNF
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| The medicare RBRVS is based upon three factors: | Physician's work (procedure) + Practice Expense + Liability
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| The PPS systems are "peer reviewed" in order to monitor | Quality of care, appropriate admissions and discharges, appropriateness of outlier cases.
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| Outlier | A term in statistics that is used to describe elements that do not fit the norm. In the DRG system for example, this someone with more than one diagnosis upon admission.
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| Today's billing software is able to: (list at least 4 items) | IN YO NOTES
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| Account aging or Patient Aging | Listing all patients/accounts with a balance unpaid for 30, 60, or 90 days.
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| Patient expectations are based upon: | previous experiences, the media, opinions of others
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| To be up front with officer policy is to be clear by having policies and accounting information | PRINTED
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| Staff members can talk about their crazy patients at lunch as long as no one overhears them. | FALSE.
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| A ___________________ is required before information can be released. | Signed "release of information". Signature must be of the patient or the guardian.
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| "Covered entities" in HIPAA refers to: | Providers, insurance plans, healthcare clearing houses.
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| Clearing houses | Electronic systems that analyze the insurance claim and screen it for errors and missing data.
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| PHI | Protected Health Information
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| Patients have the right to see and even correct errors in the medical chart | TRUE
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| Patients can get copies of their health record from clearing houses | FALSE
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| Releasing medical data without identifying the patient is called: | de-identification
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| The Truth in Lending act requires: | Clear statement of : the interest charge, when payments are due, any service charges or late payment charges
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| Fair Credit Billing Act requires: | Errors be corrected within a specified period of time.
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| Equal Credit Opportunity Act | Requires the provider to offer credit to all without discrimination
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| Primary diagnosis | Main reason for hospital admission.
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| etiology | the cause of a disease
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Created by:
rjmtoss
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