Exam 17: Reimbursement Procedures: Getting Paid

The computer software program that takes patients' coded information and identifies the DRG category is called the _____________.

Name the three components that make up a relative value unit (RVU).

Medicare and Medicaid's patient classification system,consisting of distinct groupings that provide a means for relating the type of patients a hospital treats with the costs incurred for treating them is called:

A computer software program that takes the coded information and identifies the patient's DRG category is called a:

A hospital's all-inclusive daily rates,as calculated by department,are referred to as _______.

CPT Level I and HCFA Common Procedure Coding System (HCPCS)Level II codes determine the assignment of the individual ___________ payment rate.

Define the term "cost outlier."

List the three types of firms that fall under the umbrella of a "covered entity," as named by HIPAA.

Resource utilization groups (RUGs)are used to calculate payments to a SNF according to severity and level of care.

Under the inpatient psychiatric facility PPS,federal per diem rates include geographic factors,patient characteristics,and facility characteristics.

What format do the transaction standards of HIPAA specify for electronic transactions dealing with healthcare billing and payment?

When a medical practice contracts with a "business associate," unless the business is medically related,the agreement does not have to abide by HIPAA regulations.

HIPAA standards do not address rules related to the format of electronic transactions.

The process of adjusting or canceling the balance on a patient's account after all deductibles,coinsurance amounts,and third-party payments have been made is called _________.

Under Medicare's PPS,long-term care hospitals (LTCHs)generally treat patients who require hospital-level care for an average length of stay greater than _____ days.

The amount of payment in the Prospective Payment System (PPS),based on the classification system of that service,is determined by the assigned:

The adjustment for the health condition,or clinical characteristics,and service needs of the beneficiary is referred to as the _______________.

A method of payment for healthcare services whereby the provider is paid a fixed amount for each patient regardless of the actual number or nature of services provided is called:

The typical length of stay for a patient classified to a long-term care (LTC)DRG is referred to as the:

Hospitals are paid a set fee for treating patients in a single DRG category under Medicare's PPS,regardless of the actual cost of care for the individual.