Exam 17: Reimbursement Procedures: Getting Paid

The inpatient rehabilitation facility (IRF)PPS is the reimbursement system developed by CMS to cover inpatient rehabilitation services provided to Medicare beneficiaries.

HIPAA declared that ICD-9 diagnosis and procedure codes will be replaced by ICD-10 codes as of October 1,2014.

Relative weights (RWs)and arithmetic length of stay (ALOS)both impact DRGs.

The biggest challenge in developing an RVS-based payment schedule was patient diversity.

In most cases,the unit of payment under OPPS is determined by the assignment of _____________________ and reimburses a predetermined amount based on similar clinical characteristics and similar costs of the procedure performed.

A common method of reimbursement used primarily by HMOs where the provider or healthcare facility is paid a fixed,per capita amount for each person enrolled in the plan without regard to the actual number or nature of services provided is called __________.

Skilled Nursing Facility (SNF)payment rates are adjusted for _________ and ________________,and cover all costs of furnishing covered SNF services.

Most patient accounting systems available today are capable of performing the same basic system functions.

A system of payment for healthcare services whereby the provider charges a specific fee for each service rendered and is paid that fee by the patient or by the patient's insurance carrier is called:

Name the factors on which the DRG inpatient classification system is based.

It is important to make sure products are in compliance with the HIPAA Privacy Rule when selecting a hardware/software vendor.

DRG payments for each hospital are adjusted for differences in area wages,teaching activity,care to the poor,and other factors.

When determining the applicable DRG classification,the key piece of information is the patient's:

A type of reimbursement used by CMS that bases Medicare payments on a predetermined,fixed amount (e.g.,DRGs for inpatient hospital services)is called:

Medicare payment rules are made by the:

The current Medicare RBRVS physician fee schedule is calculated using the ____________ of the service provided (identified by a CPT code)and based on the resources the service consumes.

Organizations that have the ability to force hospitals to comply with HHS admission and quality standards are called ____________________.

When an insurance carrier makes a payment to the patient/insured (or the provider)for a covered expense,it is referred to as:

The relative value of each service on Medicare's RVRVS fee schedule is multiplied by the ______________,an annually adjusted conversion factor for each Medicare locality.

Several variations of payment systems from the initial PPS currently being used by Medicare and other third-party payers in the United States have been developed by the: