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Under SNF PPS which one of the following healthcare services is excluded from the consolidated payment? a)Labs b)Routine c)Meds d)Radiation
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In SNF the rate of reimbursement is _________.
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Reimbursement Test
| Question | Answer |
|---|---|
| Under SNF PPS which one of the following healthcare services is excluded from the consolidated payment? a)Labs b)Routine c)Meds d)Radiation | Radiation |
| In SNF the rate of reimbursement is _________. | Per Diem |
| Federal Payment for SNF prospective Payment System (SNF PPS) is based on what Classification System? | Resource Utilization Groups |
| All of the following are consolidated into a single payment under the HHPPS except a)Home Health Visits b)Routine and non-routine Medical Supplies c) Nursing and therapy equipment. | Durable Medical Equipment |
| Being discharged from a Long Term Care facility to an acute care facility then back to a Longterm Care within 10 days is considered what? | Interrupted Stay |
| (T or F) Long-Term care uses LTC-MS-DRGs which are the same as the IPPS-DRGs. | True |
| Use of the charge description master has made manual coding by HIM coder obsolete. (T or F) | False |
| What is used to collect charges for healthcare at all of the points of service and electronically report to patients acct. for entry of provider claims? | Electronic order entry system |
| Revenue Cycle | Coordination of all functions that contribute to the capture, management, and collection of revenue. |
| Which is not a voluntary healthcare insurance? a)Private b)Commercial c)Medicare d)Blue Cross/Blue Sheild | Medicare |
| Which is NOT disease management? a)Preventing spread of disease b)Promotion of healthy life c)focus on single specialist for diseases d)Monitor treatment plans | Focus on single specialist for diseases |
| Which part of Medicare program was created under the Medicare Modernization Act of 2003 (MMA)and covers prescription drugs? (A, B, C or D) | D |
| What is the term that means ecaluating the appropriateness of the setting of a healthcare services? | Utilization Review |
| Which of the following characteristics is the greatest advantage of group healthcare insurance? a)smaller risk pool b) higher out of Pocket c)Greater benefits for lower premiums d) More stringent preexisting condition | Greater benefits for lower premiums |
| What is the term for the contract between the healthcare insurance company and the individual or group for whom the company is assuming the risk? | Policy |
| Medicare Part C is a _______ option known as Medicare Advantage. | Managed Care |
| What is not a high cost-sharing provision? a)Benefits b)Formulary c)Copayment d)Limitation | Benefits |
| Which TRICARE program is best for military families with no deductible,enrollment, or co-payment? | TRICARE Prime |
| (T or F)Treatment protocols that have a low risk are most likely to need a second opinion | False- they are the least likely to need a second opinion. |
| (T or F) Services offered to Medicaid beneficiaries are the same in each state. | False- Although medicaid is State and Federally funded the State creates its own criteria and rules. |
| Why did Congress pass the Health Maintenance Organization Act of 1973? | To encourage the delivery of affordable, quality healthcare. |
| All of the following attributes characterize episode-of-care reimbursement except: a)capitation b)Global Payment c) fee-for-service d)Prospective Payment | Fee for Service |
| Which would typically not require review for medical necessity and utilization: a)Rehab b)Inpatient c)Well-Baby d)Mental Health | Well Baby |
| All of the following are elements of prescription management except: a)Links to electric billing b)Formulary c)Patient Education d)Alerts for interactions | Links to Electronic Billing |
| For what type of care would you expect to have a case manager? Well Baby, Physical, Acute appendicitis, transplant? | Transplant |
| When a physicians office sent a request for payment to an Insurance company. What is this request called? | Claim |
| In the Accounting system of the physician office, the account is categorized as "Self-Pay" How should this insurance designation be interpreted? | The guarantor will pay the entire bill. |
| Which healthcare payment method does the healthcare plan over see both the costs of healthcare and the outcomes of care? | Managed Care |
| In which type of reimbursement methodology, do healthcare insurance companies reimburse providers after the costs have been incurred? | Retrospective Payment |
| What is the term for a predetermined list of charges? | Fee Schedule |
| In the healthcare industry what is the term for receiving compensation for healthcare services provided? | Reimbursement |
| In which type of reimbursement methodology does the health insurance company have the greatest risk? | Retrospective--- because the services have already been provided. |
| In which type of healthcare payment method does the healthcare plan pay for each service that a provider renders? | Fee-for-Service |
| What system was created for reporting procedures and services performed by physicians in clinical practice? | CPT |
| The codinf system that is used for reporting diagnosis for hospital inpatients in known as _____. | ICD-9-CM |
| In which type of healthcare payment method does the healthcare plan pay provides with a fixed rate for each day a covered member is hospitalized. | Per Diem |
| What does NEC mean in ICD-9-CM | Not Elsewhere Classified |
| What does NOS mean in ICD-9-CM | Not Otherwise Specified |
| What does the slanted brackets mean in ICD-9-CM | Deeper detailed code you code use as will be inside of the brackets. ex. 100.2[794.94] |
| In a typical acute care setting, Charge Entry is located in which revenue cycle area? | Claims Processing |
| In a typical acute care setting, Admitting is located in which revenue cycle area? | Pre-Claims submission |
| What data set provides the underpinning of the HHPPS? | OASIS |
| How many HHRGs are there? | 153 |
| What element is directly adjusted by the local wage index? | Labor Portion |
| Aging of accounts is the practice of counting the days, generally in _____ increments from time bill was SENT to the current day. | 30 Days |
| Generally what is the average LOS in a longterm care facility? | >25days |
| The term "soft coding" refers to what? | CPT codes that are coded by the coders |
| Which provider order entry system is usually more reliable | Paper-based |
| What risk areas are concerns when the charge description master is not properly maintained and revised? | Compliance violations may occur and reimbursement may be lost through claim denial. |
| What are the 4 names for Charge Description Master | Charge Master, Service Master, Charge Compendium and Charge List |
| What is Revenue cycle? | A regular income and repeating set of events that produces it. |
| (T or F)Being Proactive is a characteristic of the "Old" RCM approach. | False |
| What is the Case Mix Index | The average of the sum of the relative weight of all the patients treated during a specific time period. |
| Each RVU comprises three national average elements, What are they? | Physician Work, Practice Expenses and Malpractice |
| Is the status indicator C for inpatient, outpatient or both? | Inpatient only |
| What is Disproportionate Share Hospitals | The High percentage of low income patients |
| RVUs are based on ______ Coding | CPT |
| List the 5 Patient-Level Adjustments | LOS, MS-DRG w/principle dx mental illness, Co-morbid condition, Age of Patient, Electro therapy |
| List the 5 facility-Level Adjustments | Wage index, Cost of Living, Rural Location, Teaching Status, Full-service ER |
| What was the pass through category developed for? | High cost of drugs and devices |
| Skilled Professionals get paid on a ______ basis | Per Diem |
| What is OASIS | Set of data elements that represent core items of a comprehensive assessment for an adult home care patients. |
| _________ is used to measure patients outcomes in outcome based quality improvement | OASIS |
| What is OASIS based on? | Home health prospective payment systems (HHPPS) |
| When was HOPPS created? | in 1997 by the Balance Budget Act for Medicare beneficiaries |
| Types of MCOs | HMO, PPO, POS and EPO |
| What is HMO | Health Mantenance Organization- This combines the provision of healthcare insurance and the delivery of healthcare services. |
| What is PPO | Preffered Provider Organization- This contracts with employers and insurers to render services to a group of members it also contracts with providers for healthcare services at a fixed or discounted rate |
| What is POS | Point-of-Service: Members choose how to recieve service at the time they need the service (Gatekeepingm Cost Sharing,Out-of-networks, prescriptions) |
| What is EPO | Exclusive Provider Organization- MCO that is sponsered by self insured employers and associates |
| What are three types of Episode of Care? | Capitated, Global Payment and Retrospective Payment |
Created by:
mrskater