Exam 17: Reimbursement Procedures: Getting Paid

When treating a typical inpatient in a given DRG,prospective payment rates are set at a level intended to cover operating costs.

Although reporting formats vary with different patient accounting software systems,most systems are capable of producing certain standard reports.Name at least five of these standard reports.

The ________________ program employs a CMS hierarchical condition category (HCC)risk assessment payment model.

A system of classifying hospital inpatient cases into categories with similar use of the facility's resources is __________.

Bad debt write-offs are the same as contractual write-offs.

Which of the following is not one of the three components that make up the total relative value unit (RVU)?

PPS is Medicare's system for reimbursing Part A inpatient hospital costs,and the amount of payment is determined by the assigned diagnosis-related group (DRG).

The Prospective Payment System (PPS)is Medicare's system for reimbursing which of the following?

A patient's DRG categorization depends on the coding and classification of the patient's admitting diagnosis only.

Non-PARs not accepting assignment can charge beneficiaries no more than _____ % of the Medicare allowed fee.

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

Congress establishes all Medicare and Medicaid payment rules.