Exam 17: Reimbursement Procedures: Getting Paid

Explain a "contractual write-off."

Each long-term care DRG has a predetermined _________________ or the typical length of stay for a patient classified to the LTC-DRG.

Under the hospice payment system,there is a per diem rate for each day of care classified into one of four levels,which are:

More and more practices are converting to a provider fee schedule that is based on:

Medicare beneficiaries are the only patients who are included in the prospective payment system (PPS).

The acronym for the system designed to explain the amount and type of resources used in an outpatient encounter is ______.

The presence of one or more disorders/diseases in addition to the primary disorder/disease is called a:

Also taken into consideration when assigning DRGs is the patient's principal procedure and any additional operations or procedures done during the time spent in the hospital.

An agreement between the provider and a third-party payer whereby the provider agrees to accept the payer's allowed fee as payment in full for a particular service or procedure is referred to as:

Peer review organizations (PROs)only deal with organizations that involve healthcare.

The DRG reimbursement system is used in both Medicare and Medicaid healthcare programs.

The established payment rate for all services that a patient in an acute care hospital receives is based on the highest payment level experienced in the DRG category.

The federal payment rate adjustment for LTCH stays that are significantly shorter than the average length of stay for a long-term care DRG is referred to as:

Before disclosing a patient's protected health information (PHI),except for the purposes of treatment,payment,or healthcare operations,what must the practice obtain?

Services provided under the hospital outpatient prospective payment system (OPPS)are classified and paid according to:

The basic idea of resource utilization groups (RUGs)is to calculate payments to:

The basic idea of RUGs is to calculate payments to a critical care unit.

Identify which of the following is the organization (composed of physicians and other healthcare professionals)established by TEFRA to review quality of care and appropriateness of admissions,readmissions,and discharges for Medicare and Medicaid patients.

To qualify for IRF PPS rates,an inpatient hospital must establish that 100% of its patients meet certain criteria for intensive inpatient rehabilitation.

Many different computerized patient accounting systems are currently available for medical facilities;all are capable of performing a variety of system functions.List at least five of these functions.