reimbursement methodologies quiz 3

Long-term acute care hospitals are defined by Medicare as having an average inpatient length of stay greater than __________.

25 days

Which of these is part of the IPPS payment system that CMS uses to reimburse acute inpatient services?

DRGs

An ambulatory surgical center (ASC) is a federally licensed, Medicare-certified supplier of surgical healthcare services that must accept assignment of medical claims.

False

An outpatient encounter includes all outpatient procedures and services provided during the patient's entire stay.

False

Hospital inpatient departments that perform surgery are reimbursed under OPPS, the outpatient prospective payment system

False

The IPPS five-day window requires outpatient preadmission services provided by a hospital on the day of, or during the five days prior to, a patient's admission to be covered by the IPPS DRG payment.

False

A Medicare administrative contractor (MAC) is a third-party payer that contracts with Medicare to carry out the operational functions of the Medicare program.

True

A facility's case mix is a measure of the types of patients treated, and it reflects patient utilization of varying levels of healthcare resources.

True

A valid ICD-10-CM diagnosis code must be reported for each line item on electronically submitted claims.

True

DRGs are organized into mutually exclusive categories called major diagnostic categories (MDCs).

True

HCFA (now CMS) implemented the first prospective payment system (PPS) to control the cost of hospital inpatient care

True

The Medicare durable medical equipment, prosthetic/orthotics, and supplies (DMEPOS) fee schedule was established by the Deficit Reduction Act of 1984.

True

The Medicare physician fee schedule (MPFS) reimburses providers according to predetermined rates assigned to services and is revised by CMS each year.

True

Unusually costly inpatient cases that receive increased Medicare payments are called outliers.

True

Which of the following is a federal healthcare program?

a. CHAMPVA b. Indian Health Service c. Medicaid D. all of these

__________ is a data set based on local fee schedules for outpatient clinical diagnostic laboratory services

clinical laboratory fee schedule

Which of the following is a predetermined reimbursement methodology?

prospective payment system

Reimbursement according to a __________ means that hospitals reported actual charges for inpatient care to payers after discharge of the patients from the hospital.

retrospective reasonable cost system

What does the acronym ROM stand for?

risk of mortality

What does the acronym SOI stand for?

severity of illness