Principals of HC Reimbursement AHIMA
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| show | Reduction of a person's or a group's exposure to risk for unknown healthcare costs by the assumption of that risk by an entity
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| The physician's office sent a request for payment to Able Insurance. The term used in the HC industry for this request for payment is a(n): | show 🗑
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| In which type of reimbursement methodology, do HC insurance companies reimburse providers after the costs have been incurred? | show 🗑
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| show | Reimbursement
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| To which of the following factors in health insurance status most closely linked? | show 🗑
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| show | Fee-for-service reimbursement
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| In the HC industry, what is another term for "charge"? | show 🗑
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| show | The guarantor will pay the entire bill
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| What is the term for a predetermined list of charges? | show 🗑
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| show | Per diem
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| The coding system that is used primarily for reporting Dx for hospital inpatients is known as: | show 🗑
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| Which coding system was created for reporting procedures and services performed by physicians in clinical practice? | show 🗑
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| Under MS-DRGs, all of the following factors influence a facility's case mix index except for: | show 🗑
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| show | Determine the correct MS-DRG assignment for an encounter
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| show | Makes it lower than warranted by the actual service/resource intensity of the facility
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| Which of the following is the correct format for HCPCS Level II codes? | show 🗑
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| show | Operation Restore Trust
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| The 6th scope of Work for QIO introduced which of the following? | show 🗑
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| The policies and procedures section of coding compliance plan should include: | show 🗑
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| show | CCs can be over-coded by coders and
CCs can be under-coded by coders
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| show | Medicare
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| show | Employer based HC insurance plan
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| show | Greater benefits for lower premiums
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| show | Coinsurance
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| show | Medically necessary
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| show | Policy
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| show | Part D
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| This program formerly CHAMPUS Provides coverage for the dependents of active members of the armed forces: | show 🗑
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| Which government sponsored programs replaced the aid to families with dependent children AFDC program in 1996? | show 🗑
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| Which of the following is not a function of the indian health service IHS? | show 🗑
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| show | spouse or widow of a veteran meeting specific criteria and children of a veteran meeting specific criteria
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| which of the following is/are true of SCHIP? | show 🗑
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| show | 4
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| Medicare part c is a ______ option known as medicare advantage: | show 🗑
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| All of the following are true of state medical programs except: | show 🗑
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| Which TRICARE Program offers services to active duty family members (ADFMs) With no enrollment, deductible, or copayment fees for covered services? | show 🗑
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| All of the following are characteristics of managed care organizations except: | show 🗑
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| Access to mental or behavioral health medical specialists is through referral. What is the term for the person who makes the referral? | show 🗑
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| show | Utilization review
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| show | Standard of care for health condition
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| All of the following sets represent criteria for medical necessity and utilization review except: | show 🗑
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| show | Well-baby check
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| Gatekeepers determine the appropriateness of all of the following components except: | show 🗑
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| show | Precertification
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| show | Denial of reimbursement for the surgery
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| show | Medicare Advantage
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| show | The increase in Medicare expenditures for inpatient hospital care jeopardized Medicare's ability to fund other health programs.
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| show | Incentive for cost control because hospitals retain profits or suffer losses based on differences between payment rate and actual costs
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| show | Case mix index
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| show | Progress notes
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| show | Grouper
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| What is Medicare's term for a facility with a high percentage of low income patients? | show 🗑
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| In MS-DRGs, for what is the case mix index a proxy? | show 🗑
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| In the IPPS, what is the term for each hospital's unique standardized amount based on its costs per Medicare discharge? | show 🗑
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| Which of the following is not a patient level adjustment used in the IPF PPS? | show 🗑
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| Medicare inpatient reimbursement levels are based on _____ | show 🗑
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| Which of the following sites is considered a facility in the RBRVS payment system? | show 🗑
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| show | d. APCs are based on the CPT or HCPCS code(s) reported.
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| show | The cost of the service is greater than the APC payment by a fixed ratio and exceeds the APC payment plus a threshold amount
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| show | Ambulatory Payment Classifications
August 1, 2000
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| show | APGs (Ambulatory Patient Groups)
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| Under the Ambulance Fee Schedule, the _______________ is used to determine the level of service for ground transport. | show 🗑
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| When a patient is pronounced dead prior to an ambulance being called, which of the following payment provisions is followed under the Ambulance Fee Schedule? | show 🗑
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| show | The procedure in the highest level group receives full payment and the remaining receive half (50%) payment
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| The Medicare Modernization Act of 2003 mandated the creation of a new PPS for ASC services because ___________________. | show 🗑
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| show | an ASC must accept Medicare payment as payment in full
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| In which of the PAC payment systems, is the unit of payment the 60-day episode of care? | show 🗑
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| Generally, what is the average length of stay of long-term care hospitals? | show 🗑
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| Patients with all the following conditions are appropriate for LTCHs except: | show 🗑
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| show | Based on principal diagnosis
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| show | Major diagnostic category
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| show | Principal
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| show | Patient Assessment Instrument
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| All of the following services are consolidated into a single payment under the HHPPS except: | show 🗑
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| In which of the PAC payment systems, is the adjusted rate multiplied by the patient’s number of Medicare days to determine the reimbursement amount? | show 🗑
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| show | functional status
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| Which of the following is the definition of revenue cycle management? | show 🗑
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| show | CPT codes that appear in the hospital’s charge master
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| In healthcare settings, the record of the cash the facility will receive for the services it has provided is known as which of the following terms? | show 🗑
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| show | 30-day
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| Most facilities begin counting days in accounts receivable at which of the following times | show 🗑
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| show | Contractual allowance
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| show | Volunteer services
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| Which entity is responsible for processing Part A claims and hospital-based Part B claims for institutional services on behalf of Medicare? | show 🗑
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| Which of the following is not used to reconcile accounts in the patient accounting department? | show 🗑
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| What targets should be the focus of pay-for-performance or value-based purchasing systems? | show 🗑
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| show | Compensation withheld for lack of improvement
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| show | CMS, Employers, Health Plans.
All of the above
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| show | Reduce errors
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| show | Sponsors can evaluate policies and procedures
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| show | Authoritarian
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| Which of the following incentives is non-financial? | show 🗑
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| In order for P4P and VBP systems to function properly, the system must be able to identify the clinician who provided the care and is responsible for the care’s quality. In P4P and VBP, this process is known as: | show 🗑
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| show | Hospital outpatient departments and Ambulatory Surgical Centers
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| show | Staphylococcus infections
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| show | Medicare Modernization Act
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