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30 terms

CHAPTER 9

STUDY
PLAY
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