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step by step chap 16

third-party issues

The Medicare program was established in: 1965
Medicare part A pays for: hospital/facility care
Medicare Part B pays for: physician services and durable medical equipment
Who handles the day-to-day operation of the Medicare program for the CMS? fical intermediary
Medicare pays for what percentage of covered charges? 80%
The incentive to medicare participating providers is: all of the above
Who is the largest third-party payer in the nation? the government
A major change took place in medicare in _____________ with the enactment of the Omnibus Budget Reconciliation Act. 1989
The physician fee schedule is updated each April 15 and is composed of: all of the above
Services that are performed primarily in office settings are subject to a payment discount if they are performed in outpatient hospital departments. This is Called: Site of Service limitaions
If a surgeon performs more than one procedure on the same patient on the same day, discounts are made on all subsequent procedures. medicare will pay what percentages for the first, second, third, and fourth procedures? 100%, 50%, 25%, 25%
Medicare sets the payment level for assistants at surgery at what percentage of the fee schedule amount for the global surgical service? 16%
When an unlisted procedure is billed because no other code exists to describe the treatment, payment is based on a maximum of this percentage of the value of the intraoperation services originally performed. 50%
What edition of the Federal Register would hospital facilities be especially interested in? October
What edition of the Federal Register would outpatient facilities be especially interested in? November or December
What are the three items that the Medicare beneficiaries are responsible to pay before Medicare will begin to pay for services? deductibles, premiums, and coinsurance
Where and when were the DRGs first developed? Yale, 1960s
What was the state that first used the DRGs on a large scale? NJ
What is the total number of MDCs? 25
The creation of the PRO was made possible under a provision of what act? TEFRA
Which of the following is not a patient attribute for classification into a DRG? length of stay
What is the name of the document that is produced by CMS that defines the type and number of health records that must be reviewed for a patient record? Scope of Work
A complication is defined as a condition that increases the patient's length of stay in the hospital by at least 1 day in at least what percent of cases? 75%
Which of the following is not used to identify surgery unrelated to the principal diagnosis? 482
Medicare funds are collected by: Social Security Adminstration
Created by: bunnyfinley