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# BAS - Payment

# BAS - Payment, PPS, DRG, Computer

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