Health Insurance Chapter 9
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| show | ambulatory surgicval center (ASC)
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| 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. | show 🗑
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| show | (1) submitted charge, or(2) national limitation amount, or(3) local fee schedule amount, whichever is lowest.
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| Medicare reimburses ____________ either 80% of the actual charge for the item or the fee schedule amount whichever is lower. | show 🗑
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| 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. | show 🗑
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| 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). | show 🗑
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| show | home assessment validation and entry (HAVEN)
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| Diagnosis-related groups are organized into mutually exclusive categories called __________ which are loosely based on body systems. | show 🗑
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| show | (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.
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| show | medicare severity diagnosis-related groups (MS-DRGs)
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| The ____________indicator differentiates between patient conditions present upon inpatient admission and those that develop during the inpatient admission. | show 🗑
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| show | ambulatory payment classifications (APCs)
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| show | wage index
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| 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. | show 🗑
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| 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? | show 🗑
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| show | incident to
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| show | Medicare physican fee schedule (MPFS)
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| show | Complications (CCs)are conditions that arise during the hospitalization, and/or co-morbidities (CCs) are pre-existing conditions treated during the hospitalization.
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