Health insurance
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| Ambulance services use what kind of payment system for reimbursements? | Ambulance fee schedule
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| What system does the IPPS use for reimbursement? | MS-DRGS (medical severity diagnosis related groups)
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| What system does the OPPS use for reimbursement? | APCs (ambulatory payment classifications)
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| What system does SNF use for reimbursement? | RUGs (resource utilization groups)
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| What is a state-licensed, Medicare certified supplier of surgical healthcare services that must accept assignment on claims? | Ambulatory Surgical Center (ASC)
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| How does Medicare reimburse DMEPOS? (Durable Medical Equipment, Prosthetics/Orthotics, and Supplies) | Either 80% of the actual charge amount or the fee schedule amount, whichever is lowest.
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| How does Medicare reimburse laboratory services? | Either on submitted charge, national limitation amount, whichever is lowest.
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| Bundles ESRD drugs and related laboratory tests resulting in one reimbursement amount for ESRD services provided to patients is called? | ESRD composite payment rate system
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| What are the steps to HHS (Home Health Services) reimbursement? | Patient assessment,oasis,grouper,HHRG,and Haven
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| What are MS DRGs organized into? | MDC- Major Diagnostic Categories
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| In the inpatient PPS, what is assigned to each dx to differentiate between conditions present on admission and those that develop during the hospital stay? | POA-Present on Admission
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| Name the adjustments that qualifying hospitals can receive under the IPPS. | Disproportionate share hospital adjustment-DSH,Indirect medical education adjustment-IME,and Outliers
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| Medicare reimburses physician's services based on Relative Value Units assigned to each service/procedure. What does this consist of? | Physician work expense, practice expense,and malpractice expense
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| What does medicare call the EOB? | MSN- Medicare Summary Notice
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| What are the patient assessments used in Home Health PPS? | OASIS-Outcomes and Assessments information Sets
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| What is the process by which healthcare facilities and providers ensure their financial viability by increasing revenue, improving cash flow, and enhancing the patient's experience? | Revenue Cycle Management
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| What is it called when NPP's can bill services provided to Medicare beneficiaries to Medicare directly,which means their services are billed under a supervising physician? | Incident to
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| What does the acroynm CMS mean? | Centers for Medicare and Medicaid Services
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| What does the acroynm SNF mean? | Skilled Nursing facility
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| What does the acroynm MSP mean? | Medicare secondary payer
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| What does the acroynm PPS mean? | Prosepective payment system
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| What does the acroynm ASC mean? | Ambulatory surgical center
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| What does the acroynm NP mean? | Nurse practitioner
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| What does the acroynm DME mean? | Durable medical equipment
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| What does the acroynm MSN mean? | Medicare summary notice
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| What does the acroynm MPFS mean? | Medicare physician fee schedule
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| What does the acroynm RUG mean? | Resource utilization groups
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| What does the acroynm ESRD mean? | End stage renal disease
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| What does the acroynm MDC mean? | Major diagnostic category
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| What does the acroynm DSH mean? | Disproportionate share hospital
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| What does the acroynm APC mean? | Ambulatory payment classification
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| What does the acroynm OASIS mean? | Outcome and assessment information set
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| What does the acroynm MS DRG mean? | Medical severity diagnosis related groups
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| What does the acroynm IPPS mean? | Inpatient prospective payment system
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| What does the acroynm OPPS mean? | Outpatient prospective payment system
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| What does the acroynm IME mean? | Indirect medical education
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| What does the acroynm POA mean? | Present on Admission
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| What does the acroynm CC mean? | Co-morbidities
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| What does the acroynm MCC mean? | Major co-,morbidities
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