Busy. Please wait.
Log in with Clever

show password
Forgot Password?

Don't have an account?  Sign up 
Sign up using Clever

Username is available taken
show password

Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account.
Your email address is only used to allow you to reset your password. See our Privacy Policy and Terms of Service.

Already a StudyStack user? Log In

Reset Password
Enter the associated with your account, and we'll email you a link to reset your password.
Didn't know it?
click below
Knew it?
click below
Don't Know
Remaining cards (0)
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

  Normal Size     Small Size show me how


Health Insurance Chapter 9

What is a state licensed, Medicare certified supplier of surgical healthcare services that must accept assignment on claims? ambulatory surgical center (ASC)
In IPPS, this is an indicator to differentiate between conditions present upon admission and those that develop during the hospital stay present on admission (POA)
Medicare reimburses laboratory services based on what? submitted charge, national limitation amount, or local fee schedule amount, whichever is lowest
How does Medicare reimburse DMEPOS? 80% of the actual charge amount or the fee schedule amount, whichever is lowest
In the Home Health PPS, patient assessments are completed using what? outcomes and assessments information set (oasis)
In the IPPS what rule requires outpaient preadmission services provided by a hospital up to 3 days prior to the patient's admission to be covered by IPPS payment: IPPS 72-hour rule, or IPPS 3-day window rule
Medicare reimbursement for physician's services is based on Relative Value Units assigned to each service/procedure consisting of what? physician work expense, practice expense, & malpractice expense
This a condition that arises during the hospitalization that can change the patient's outcome or may require additional treatment complication
This is a pre-existing condition treated during the hospitalization, but may not be what required the hospitalization co-morbidity
Medicare non-par physicians are held to a limiting charge amount. This is what percentage of the non-par medicare physician's fee schedule amount? 115%
NPPS can bill services provided to Medicare beneficiaries as what? It means that their services are billed underr a supervising physician incident to
Home Health Services are reimbursed based on each______episode of care 60-day
DRG's are organized into what? major diagnostic categories
IPPS adjustment available for hospitals that treat a high-percentage of low-income patients disproportionate share hospital
IPPS adjustment for hospitals that treat unusually costly cases outliers
IPPS adjustment for approved teaching hospitals indirect medical education
What classification system is used for the Inpatient PPS? MS-DRG
What does MS-DRG's stand for? medical severity diagnosis-related groups
What classification system is used for the Physician Fee Schedule payment system? Resource Based Relative ValueSystem (RBRVS)
What classification system is used for the Outpatient PPS? Ambulatory Payment Classifications (APC's)
What classification system is used for the Skilled Nursing PPS? Resource Utilization Groups (RUGs)
What classification system is used for the Home Health PPS? Home Health Resource Groups (HHRGs)
What is a measure of the types of patients treated, and reflects a patient utilization of varying levels of healthcare resources for a facility? case mix
This determines the appropriate group (e.g. MS, DRG, HHRG and so on) to classify a patient after data about the patient is input grouper software
Predetermined reimbursement methodology: payment system
Extent of physiological decompensation or organ system loss of function: severity of illness
Hospitals use this to describe their patient encounter form: chargemaster
Date elements collected by long-term care facilities: minimum data set (MDS)
What do institutional and other selected providers submit their claim data on to payers for reimbursement of patient services? UB-04
What does the acronym NPP stand for? nonphysician practitioner
Name three nonphysician practitioners: nurse practitioner (NP), clinical nurse specialist (CNS), physician assistant (PA)
Which PPS provides a lump-sum payment that depends on the patient's principal diagnosis, comorbidities, complications, and principal and secondary procedures? IPPS
Which is the abbreviation for the numeric codes reported on the CMS-1500 claim that indicate where services were provided to beneficiaries? POS (place of service)
Resource utilization groups (RUGs) is a ____ reimbursement methodology used by skilled nursing facilities cost-based
Which legislated implementation of the long-term (acute) care hospital inpatient prospective payment system? BBRA
The resource-based relative value scale (RBRVS) system is more commonly called the: medicare physician fee schedule
The process by which health care facilities and payers determine anticipated care needs by reviewing tyupes and/or categories of patients treated by a facility is called_____ analysis case mix
Diagnosis-related groups are organized into mutually exclusive categories called______, which are loosely based on body systems major diagnostic categories
Physician work, practice expense, and malpractice expense are components in computing _______ for the resource-based relative value scale system relative value units
Four-digit______ codes are preprinted on a facility's chargemaster to indicate the location or type of service provided to an institutional patient revenue
Which is responsible for developing data elements reported on the UB-40? NUBC (national uniform billing committee)
Which reimbursement system established rates in advance of services and is based on reported charges from which a per diem rate is determined? prospective cost-based
A patient registered as an outpatient at a hospital presents with three encounters,what will the ambulatory patient classification reimbursement be based on? assignment of multiple APCs that reflect all services provided, with discounting
Which type of hospital is excluded from the inpatient prospectice payment system? cancer, or childrens hospitals
Which is the unit of payment for the inpatient prospective payment system? hospital admission
Which is a relative value unit in the medicare physician fee schedule payment system? practice expense
The intent of establishing a limiting charge for nonPARs is to: offer financial protection for medicare enrollees
Which is classified as a nonphysician practitioner? physician assistant, nurse practitioners, clinical nurse specialists
Which publication communicates new or changed policies and procedures that are being incorporated into a specific CMS manual? program transmittal
When an office-based service is performed in a health care facility, payment is affected by the use of: a site of service differential
Created by: kduvall20
Popular Medical sets




Use these flashcards to help memorize information. Look at the large card and try to recall what is on the other side. Then click the card to flip it. If you knew the answer, click the green Know box. Otherwise, click the red Don't know box.

When you've placed seven or more cards in the Don't know box, click "retry" to try those cards again.

If you've accidentally put the card in the wrong box, just click on the card to take it out of the box.

You can also use your keyboard to move the cards as follows:

If you are logged in to your account, this website will remember which cards you know and don't know so that they are in the same box the next time you log in.

When you need a break, try one of the other activities listed below the flashcards like Matching, Snowman, or Hungry Bug. Although it may feel like you're playing a game, your brain is still making more connections with the information to help you out.

To see how well you know the information, try the Quiz or Test activity.

Pass complete!
"Know" box contains:
Time elapsed:
restart all cards