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Understanding Health Insurance

Health & Kinesiology

Quiz 9 :

Cms Reimbursement Methodologies

Quiz 9 :

Cms Reimbursement Methodologies

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Each home health resource group (HHRG) has an associated __________ that increases or decreases Medicare's payment for an episode of home health care.
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Answer:

D

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The MMA of 2003 mandated implementation of a(n) __________ payment amount as a substitute for the Ambulatory Surgical Center (ASC) standard overhead amount for surgical procedures performed at an ASC.
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Answer:

C

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

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Diagnosis-related groups are organized into mutually exclusive categories called __________, which are loosely based on body systems.
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Which is associated with a particular category of patient and is established by the payer prior to the provision of health care services?
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The inpatient prospective payment system (IPPS) resulted in Medicare reimbursing hospitals for inpatient hospital services according to a __________ rate for each discharge.
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In 1980 Medicare authorized implementation of ambulatory surgical center __________ rates as a fee to ambulatory surgery centers (ASCs) for facility services furnished in connection with performing certain surgical procedures.
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The Medicare durable medical equipment, prosthetics/orthotics, and supplies (DMEPOS) fee schedule reimburses DMEPOS either __________ percent of the actual charge for the item or the fee schedule amount, whichever is lower.
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Medicare reimburses laboratory services according to a(n) __________, which is based on the submitted charge, national limitation amount, or local fee schedule amount, whichever is lowest.
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The federal government administers several health care programs, some of which require services to be reimbursed according to predetermined reimbursement methodologies, which are established as __________.
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The ambulance fee schedule payment system replaced a __________ for providers and suppliers of ambulance services.
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Home health resource groups are reported to Medicare on UB-04 using the __________ code set, which represents case-mix groups about which payment determinations are made for the home health prospective payment system.
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Which is established in advance and based on reported health care charges from which a predetermined per diem rate is determined?
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Home Assessment Validation and Entry (HAVEN) __________ software is then used to collect OASIS assessment data for transmission to state databases.
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The end-stage renal disease (ESRD) composite payment rate system is __________ adjusted to provide a mechanism to account for differences in patients' utilization of health care resources.
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HIPPS codes are determined after home health care patient assessments using the __________ are completed.
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Which is a facility's measure of the types of patients treated and reflects patient utilization of varying levels of health care resources?
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An ambulatory surgical center (ASC) is a state-licensed, Medicare-certified supplier (not provider) of surgical health care services that must __________ on Medicare claims.
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Which type of software is used to determine the appropriate HHRG after OASIS data is input on each patient (to measure the outcome of all adult patients receiving home health services)?
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DRG reimbursement rates are recalculated according to a(n) __________ adjustment, which results in increased Medicare payments for hospitals that treat a high percentage of low-income patients.
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