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chapter 9 HI

Health insurance

Ambulance services use what kind of payment system for reimbursements? Ambulance fee schedule
What system does the IPPS use for reimbursement? MS-DRGS (medical severity diagnosis related groups)
What system does the OPPS use for reimbursement? APCs (ambulatory payment classifications)
What system does SNF use for reimbursement? RUGs (resource utilization groups)
What is a state-licensed, Medicare certified supplier of surgical healthcare services that must accept assignment on claims? Ambulatory Surgical Center (ASC)
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.
How does Medicare reimburse laboratory services? Either on submitted charge, national limitation amount, whichever is lowest.
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
What are the steps to HHS (Home Health Services) reimbursement? Patient assessment,oasis,grouper,HHRG,and Haven
What are MS DRGs organized into? MDC- Major Diagnostic Categories
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
Name the adjustments that qualifying hospitals can receive under the IPPS. Disproportionate share hospital adjustment-DSH,Indirect medical education adjustment-IME,and Outliers
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
What does medicare call the EOB? MSN- Medicare Summary Notice
What are the patient assessments used in Home Health PPS? OASIS-Outcomes and Assessments information Sets
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
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
What does the acroynm CMS mean? Centers for Medicare and Medicaid Services
What does the acroynm SNF mean? Skilled Nursing facility
What does the acroynm MSP mean? Medicare secondary payer
What does the acroynm PPS mean? Prosepective payment system
What does the acroynm ASC mean? Ambulatory surgical center
What does the acroynm NP mean? Nurse practitioner
What does the acroynm DME mean? Durable medical equipment
What does the acroynm MSN mean? Medicare summary notice
What does the acroynm MPFS mean? Medicare physician fee schedule
What does the acroynm RUG mean? Resource utilization groups
What does the acroynm ESRD mean? End stage renal disease
What does the acroynm MDC mean? Major diagnostic category
What does the acroynm DSH mean? Disproportionate share hospital
What does the acroynm APC mean? Ambulatory payment classification
What does the acroynm OASIS mean? Outcome and assessment information set
What does the acroynm MS DRG mean? Medical severity diagnosis related groups
What does the acroynm IPPS mean? Inpatient prospective payment system
What does the acroynm OPPS mean? Outpatient prospective payment system
What does the acroynm IME mean? Indirect medical education
What does the acroynm POA mean? Present on Admission
What does the acroynm CC mean? Co-morbidities
What does the acroynm MCC mean? Major co-,morbidities
Created by: corrine I
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