Question 1

Which is the extent of physiological decompensation or organ system loss of function?
A) case-mix management
B) intensity of resources
C) risk of mortality
D) severity of illness

Accepted Answer

Severity of illness refers to the extent of physiological decompensation or organ system loss of function.

Question 2

Which was adopted by Medicare in 2008 to improve recognition of severity of illness and resource consumption and reduce cost variation among DRGs?
A) DRGs
B) AP-DRGs
C) APR-DRGs
D) MS-DRGs

Accepted Answer

Medicare adopted MS-DRGs (Medicare Severity Diagnosis Related Groups) in 2008 to better account for the severity of illness and resource consumption, aiming to reduce cost variation among DRGs.

Question 3

The outpatient prospective payment system reimburses services according to ambulatory payment classifications (APCs), which group services according to similar __________ and in terms of resources required.
A) clinical characteristics
B) intensity of resources
C) risk of mortality
D) severity of illness

Accepted Answer

APCs group services based on similar clinical characteristics and the resources required for those services.

Question 4

Which adjusts payments to account for geographic variations in hospitals' labor costs?
A) case index
B) disease index
C) morbidity index
D) wage index

Accepted Answer

The wage index is used to adjust payments to hospitals to account for geographic variations in labor costs.

Question 5

Which is the relative volume and types of diagnostic, therapeutic, and inpatient bed services used to manage an inpatient disease?
A) case mix management
B) intensity of resources
C) risk of mortality
D) severity of illness

Accepted Answer

Intensity of resources refers to the relative volume and types of diagnostic, therapeutic, and inpatient bed services used to manage an inpatient disease.

Question 6

Which was adopted for one year by Medicare in 2007 to reimburse hospitals for inpatient care provided to Medicare beneficiaries?
A) DRGs
B) AP-DRGs
C) APR-DRGs
D) MS-DRGs

Accepted Answer

APR-DRGs were adopted for one year by Medicare in 2007 to reimburse hospitals for inpatient care provided to Medicare beneficiaries.

Question 7

Which includes all outpatient procedures and services provided during one day to the same patient?
A) limited data set
B) diagnosis-related group
C) outpatient encounter
D) relative value unit

Accepted Answer

An outpatient encounter includes all procedures and services provided to a patient during a single day without being admitted to the hospital.

Question 8

Long-term acute care hospitals are defined by Medicare as having an average inpatient length of stay greater than __________ days.
A) 10
B) 15
C) 25
D) 30

Accepted Answer

Medicare defines long-term acute care hospitals as facilities with an average inpatient length of stay greater than 25 days.

Question 9

Hospitals that treat unusually costly cases receive increased __________ payments that are designed to protect hospitals from large financial losses due to unusually expensive cases.
A) disproportionate
B) indirect
C) outlier
D) severity

Accepted Answer

Outlier payments are additional payments made to hospitals for cases that are significantly more costly than average, to protect them from financial losses.

Question 10

Which is the likelihood of dying?
A) case-mix management
B) intensity of resources
C) risk of mortality
D) severity of illness

Accepted Answer

Risk of mortality refers to the likelihood or probability of a patient dying, often used in medical assessments and predictions.

Question 11

Approved teaching hospitals receive increased Medicare payments according to a(n) __________ adjustment.
A) disproportionate share hospital
B) indirect medical education
C) risk of inpatient patient mortality
D) severity of inpatient illness

Accepted Answer

Approved teaching hospitals receive increased Medicare payments through an indirect medical education (IME) adjustment to compensate for the higher costs associated with training medical residents.

Question 12

Which rule applies when patients are discharged from the hospital directly to a postacute provider?
A) 3-day payment window rule
B) intensity of resources rule
C) severity of illness rule
D) transfer rule

Accepted Answer

The transfer rule applies when patients are discharged from the hospital directly to a postacute provider, as it involves specific billing and payment guidelines for such transfers.

Question 13

Which classifies patients into inpatient rehabilitation facility prospective payment system groups that are based on clinical characteristics and expected resource needs?
A) charge description master
B) fee schedule
C) HIPPS code set
D) patient assessment instrument

Accepted Answer

The patient assessment instrument is used to classify patients into groups for the inpatient rehabilitation facility prospective payment system based on clinical characteristics and expected resource needs.

Question 14

Which replaced the reasonable cost-based payment system for long-term (acute) care hospitals?
A) cost-based system
B) per diem system
C) prospective payment system
D) retrospective payment system

Accepted Answer

The prospective payment system replaced the reasonable cost-based payment system for long-term (acute) care hospitals, establishing predetermined rates.

Question 15

Providers that use the Diagnostic and Statistical Manual refer to diagnostic assessment criteria that are used as tools to identify __________ disorders.
A) ambulatory
B) inpatient
C) medical
D) psychiatric

Accepted Answer

The Diagnostic and Statistical Manual (DSM) is used primarily for diagnosing psychiatric disorders.

Question 16

When outpatient preadmission services are provided by a hospital on the day of or during the three days prior to a patient's inpatient admission and the inpatient principal diagnosis code exactly matches that for preadmission services, the IPPS __________ rule applies.
A) 3-day payment window
B) intensity of resources
C) severity of illness
D) transfer

Accepted Answer

The 3-day payment window rule applies when outpatient services are provided by a hospital on the day of or within three days prior to an inpatient admission, and the principal diagnosis code matches.

Question 17

Which software is used for the computerized data entry of the minimum data set about skilled nursing facility patients to create a file in a standard format that can be electronically transmitted to a state database?
A) HAVEN
B) IRVEN
C) OASIS
D) RAVEN

Accepted Answer

RAVEN (Resident Assessment Validation and Entry) is the software used for the computerized data entry of the minimum data set (MDS) for skilled nursing facility patients, allowing the data to be electronically transmitted to a state database.

Question 18

Provisions of the inpatient psychiatric facility prospective payment system resulted in a __________ patient classification system that reflects differences in patient resource use and costs.
A) cost-based
B) price-based
C) per diem
D) prospective

Accepted Answer

The answer of Provisions of the inpatient psychiatric facility prospective...

Question 19

Inpatient rehabilitation facilities use __________ software for computerized data entry to create a file in a standard format that can be electronically transmitted to a national database.
A) HAVEN
B) IRVEN
C) OASIS
D) RAVEN

Accepted Answer

IRVEN (Inpatient Rehabilitation Validation and Entry) software is specifically used by inpatient rehabilitation facilities for data entry and transmission to a national database.

Question 20

Which is the original DRG system adapted for use by third-party payers to reimburse hospitals for inpatient care provided to non-Medicare beneficiaries (e.g., BlueCross BlueShield) and is based on intensity of resources?
A) DRGs
B) AP-DRGs
C) APR-DRGs
D) MS-DRGs

Accepted Answer

AP-DRGs (All Patient Diagnosis Related Groups) are the original DRG system adapted for use by third-party payers to reimburse hospitals for inpatient care provided to non-Medicare beneficiaries, and they are based on the intensity of resources used.

Quiz 9: Cms Reimbursement Methodologies

Which is the extent of physiological decompensation or organ system loss of function?

Which was adopted by Medicare in 2008 to improve recognition of severity of illness and resource consumption and reduce cost variation among DRGs?

The outpatient prospective payment system reimburses services according to ambulatory payment classifications (APCs) , which group services according to similar __________ and in terms of resources required.

Which adjusts payments to account for geographic variations in hospitals' labor costs?

Which is the relative volume and types of diagnostic, therapeutic, and inpatient bed services used to manage an inpatient disease?

Which was adopted for one year by Medicare in 2007 to reimburse hospitals for inpatient care provided to Medicare beneficiaries?

Which includes all outpatient procedures and services provided during one day to the same patient?

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

Hospitals that treat unusually costly cases receive increased __________ payments that are designed to protect hospitals from large financial losses due to unusually expensive cases.

Which is the likelihood of dying?

Approved teaching hospitals receive increased Medicare payments according to a(n) __________ adjustment.

Which rule applies when patients are discharged from the hospital directly to a postacute provider?

Which classifies patients into inpatient rehabilitation facility prospective payment system groups that are based on clinical characteristics and expected resource needs?

Which replaced the reasonable cost-based payment system for long-term (acute) care hospitals?

Providers that use the Diagnostic and Statistical Manual refer to diagnostic assessment criteria that are used as tools to identify __________ disorders.

When outpatient preadmission services are provided by a hospital on the day of or during the three days prior to a patient's inpatient admission and the inpatient principal diagnosis code exactly matches that for preadmission services, the IPPS __________ rule applies.

Which software is used for the computerized data entry of the minimum data set about skilled nursing facility patients to create a file in a standard format that can be electronically transmitted to a state database?

Provisions of the inpatient psychiatric facility prospective payment system resulted in a __________ patient classification system that reflects differences in patient resource use and costs.

Inpatient rehabilitation facilities use __________ software for computerized data entry to create a file in a standard format that can be electronically transmitted to a national database.

Which is the original DRG system adapted for use by third-party payers to reimburse hospitals for inpatient care provided to non-Medicare beneficiaries (e.g., BlueCross BlueShield) and is based on intensity of resources?