Help
Options
Question
An _____ is a state-licensed, Medicare-certified supplier (not provider) of surgical healthcare services that must accept assignment on Medicare claims. It must be a separate entity distinguishable from any other facility and must have its own EIN.
click to flip
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't know
Question
The Deficit Reduction Act of 1984 established the Medicare ____________, which is a data set based on local fee schedules (for outpatient clinical diagnostic laboratory services.
Remaining cards (17)
Know
retry
shuffle
restart
0:00
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
Normal Size Small Size show me how
ljlindrose61
Health Insurance Chapter 9
| Question | Answer |
|---|---|
| An _____ is a state-licensed, Medicare-certified supplier (not provider) of surgical healthcare services that must accept assignment on Medicare claims. It must be a separate entity distinguishable from any other facility and must have its own EIN. | ambulatory surgicval center (ASC) |
| The Deficit Reduction Act of 1984 established the Medicare ____________, which is a data set based on local fee schedules (for outpatient clinical diagnostic laboratory services. | clinical laboratory fee schedule |
| Medicare reimburses laboratory services according to what? | (1) submitted charge, or(2) national limitation amount, or(3) local fee schedule amount, whichever is lowest. |
| Medicare reimburses ____________ either 80% of the actual charge for the item or the fee schedule amount whichever is lower. | durable medical equipment, prosthetics/orthotics, and supplies (DMEPOS) |
| The Home Health Prospective Payment System uses ____________ which classifies patients into one of 80 groups. Each group has an associated weight value that increases or decreases Medicare's payment for an episode of home health care. | home health resource groups (HHRGs). |
| This is used to determine the appropriate HHRG after Outcomes and Assessment Information Set (OASIS) is input on each patient (to measure the outcome of all adult patients receiving home health services). | grouper software |
| This data entry software is used to collect OASIS assessment data for transmission to state databases. | home assessment validation and entry (HAVEN) |
| Diagnosis-related groups are organized into mutually exclusive categories called __________ which are loosely based on body systems. | major diagnositc categories (MDCs) |
| Each DRG has a payment weight assigned to it, based on the average resources used to treat Medicare patients in that DRG, and the reimbursement rate can be adjusted according to the following guidelines: | (1) Disproportionate share hospital (DSH) for hospitals that treat a high-percentage of low-income patients (2) Indirect medical education (IME) adjustment for approved teaching hospitals. (3) Outliers for hopsitals that treat unusally costly cases. |
| The Inpatient Prospective Payment System (IPPS) uses a payment system called __________ to classify patients into one of 745 groups. | medicare severity diagnosis-related groups (MS-DRGs) |
| The ____________indicator differentiates between patient conditions present upon inpatient admission and those that develop during the inpatient admission. | present on admission (POA) |
| The outpatient prospective payment system (OPPS) for hospital outpatient services provided to Medicare patients are paid according to ____________ which group services according to similar clinical characteristics and in terms of resources required. | ambulatory payment classifications (APCs) |
| This adjusts payments to account for geographic variations in hospitals' labor costs. | wage index |
| A skilled nursing facility (SNF) per diem payments are case-mix adjusted using a resident classification system called _____________ based on data from resident assessments and relative weights developed from staff time data. Cost-based. | resource utilization groups (RUGs) |
| Physician services are reimbursed according to a payment system called Resource based relative value system (RBRVS) also called the Medicare physican fee schedule. All services are assigned relative value units (RVUs) consisting of what? | (1) physician work (2) practice expense (3) malpractice expense |
| Services provided by nonphysician practitioners may also be reported to Medicare as _____________to the supervising physician's service and are reimbursed at 100 percent of the Medicare physician fee schedule. | incident to |
| The Resource-Based Relative Value Scale (RBRVS) is now called the ______________ | Medicare physican fee schedule (MPFS) |
| In the MS-DRG system, some DRGs have been further refined by what? | Complications (CCs)are conditions that arise during the hospitalization, and/or co-morbidities (CCs) are pre-existing conditions treated during the hospitalization. |
Created by:
ljlindrose61