CHAPTER 9

30 terms by emmac222 

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HCFA (NOW CMS) IMPLEMENTED THE FIRST PROSPECTIVE PAYMENT SYSTEM (PPS) TO CONTROL THE COST OF HOSPITAL INPATIENT CARE

TRUE

AN AMBULATORY SURGICAL VENTER IS A FEDERALLY LICENSED, MEDICARE CERTIFIED SUPPLIER OF SURGICAL HEALTH CARE SERVICES THAT MUST ACCEPT ASSIGNMENT OF MEDICAL CLAIMS

FALSE

HOSPITAL INPATIENT DEPARTMENTS THAT PERFORM SURGERY ARE REIMBURSED UNDER OPPS, THE OUTPATIENT PAYMENT SYSTE,

FALSE

THE MEDICARE DURABLE MEDICAL EQUIPMENT PROSTECTIC/ORTHOICS AND SUPLIERS (DMEPOS) FEE SCHEDULE WAS ESTABLISHED BY THE DEFICIT REDUCTION ACT OF 1984

TRUE

A VALID ICD-9 CM DIAGNOSIS CODE MUST BE REPORTED FOR EACH LINE ITEM ON ELECTRONICALLY-SUBMITTED CLAIMS

TRUE

CPT CODES DIRECTLY AFFECT DRG'S ASSINGMENT

FALSE

DRG'S ARE ORGANIZED INTO MUTUALLY EXCLUSIVE CATEFORIES CALLED MAJOR DIAGNOSTIC CATEGORIES (MDCS)

TRUE

PAYING ACCORDING TO A COMPOSITE RATE IS A COMMON FORM OF MEDICARE PAYMENT, ALSO KNOWN AS UNBUNDLING.

FALSE

A FACILITY CASE MIS IS A MEASURE OF THE TYPES OF PATIENTS TREATED,AND IT REFLECTS PATIENT UTILIZATION OF VARYING LEVELS OF HEALTH CARE RESOURCES

TRUE

DECISION TREEE ARE USED BY CODERS AND BILLERS TO CALCULATE REIMBURSMENT

FALSE

HOSPITALS THAT TREAT USUALLY COSTLY CASES AND RECIEVE INCREASED MEDICARE PAYMENTS ARE CALLED OUTLIERS

TRUE

A MEDICARE ADMINSTRATIVE CONTACTOR IS A THIRD PARTY PAYER THAT CONTACTS WITH MEDICARE TO CARRY OUT THE OPERATIONAL FUNCTIONS OF THE MEDICARE PROGRAM

TRUE

AN OUTPATIENT ENCOUNTER INCLUDES ALL OUTPATIENT PROCEDURES AND SERVIES PROVIDED DURING THE PATIENTS ENTIRE STAY

FALSE

APC GROUPER SOFTWARE IS USED TO ASSIGN AN APC TO EACH CPT AND OR HCPC LEVEL II CODE REPORTED ON AN INPATIENT CLAIM, AS WEL AS TO REPORT ICD 9-CM DIAGNOSIS CODES AS APPROPRIATE

FALSE

THE MEDICARE PHYSICIANS FEE SCHEDULE REIMBURES PROVIDERS ACCORDING TO PREDETERMINED RATES ASSIGNED TO SERVICES AND IS REVISED BY CMS EACH YEAR

TRUE

WHAT DOES THE ACRONYM SOI STAND FOR

SERVERITY OF ILLNESS

WHAT DOES THE ACRONYM ROM STAND FOR

RICK OF MORTALITY

REIMBURSMENT ACCORDING TO ____ MEANS THAT HOPSITALS REPORTED ACTUAL CHARGES FOR INPATIENT CARE TO PAYERS AFTER DISCHARGE OF THE PATIENTS FROM THE HOSPITAL

PAYMENT SYSTEM

WHICH OF THE FOLLOWING IS A FEDERAL HEALTH CARE PROGRAM

ALL OF THE ABOVE

WHICH IS A PREDETERMINED REIMBURSEMENT METHODOLOGY

PAYMENT SYSTEM

WHAT IS THE NAME OF THE PAYMENT SYSTEM FOR AMBULANCE SERVICES PROVIDED TO MEDICARE BENEFICIARIES

AMBULANCE FEE SCHEDULE

WHICH OF THE FOLLWOING IS A LEVE OR AMBULANCE SERVICE

ALL OF THE ABOVE

_____ IS A DATA SET BASED ON LOCAL FEE SCHEDULES FOR OUTPATIENT CLINICAL DIAGNOSTIC LABORATORY SERVICES

CLINICAL LABORATORY FEE SCHEDULE

MEDICARE REIMBURSES LABORATY SERVICES ACCORDING TO

ALL OF THE ABOVE

A FACILITIES_______ IS A MEASURE OF THE TYPES OF PATIENTS TREATED, AND IT REFLECTS PATIENT UTILIZATION OF CARYING LEVELS OF HEALTHER CARE RESOURCES

CASE MIX

LONG TERM ACURE CARE HOPSITALS ARE DEFINED BY MEDICARE AS HAVING AN AVERAGE INPATIENT LENGTH STAY OF GREATER THEN

25 DAYS

THE ____ REIMBURSES PROVIDERS ACCORDING TO PREDETERMINED RATES ASSIGNED TO SERVICES AND IS REVISED BY CMS A YEAR

MEDICARE PHTSICIAS SCHEDULE

MEDICARE IS ALWAYS A SECONDARY PAYER WHEN A MEDICARE BENEFICIARY ALSO HAS COVERAGE FROM WHICH OF THE FOLLOWING GROUPS

ALL OF THE ABOVE

WHICH OF THE FOLLOWING INFORMATIN IS NECCESSARY TO CLACULATE THE AMOUNT OF MEDICARE SECONDARY BENIFITS PAYABLE ON A GIVEN CLAIM

BOTH A AND C

THE ____ IS A DOCUMENT THAT CONTAINS A COMPUTER GENERATED LIST OF PROCEDURES, SERVICES, AND SUPPLIES WITH CHARGES FOR EACH

BOTH A AND B

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