Exam 9: Cms Reimbursement Methodologies

The Medicare durable medical equipment, prosthetics/orthotics, and supplies (DMEPOS) fee schedule reimburses DMEPOS either __________ percent of the actual charge for the item or the fee schedule amount, whichever is lower.

In 1980 Medicare authorized implementation of ambulatory surgical center __________ rates as a fee to ambulatory surgery centers (ASCs) for facility services furnished in connection with performing certain surgical procedures.

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.

The process of extracting and analyzing data to identify patterns, whether predictable or unpredictable, is called data __________.

Which communicates new or changed policies and/or procedures that are being incorporated into a specific CMS Internet-only program manual?

A condition that exists at the time an order for inpatient admission occurs is categorized according to __________.​

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

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

An ambulatory surgical center (ASC) is a state-licensed, Medicare-certified supplier (not provider) of surgical health care services that must __________ on Medicare claims.

Which reimburses providers according to predetermined rates assigned to services and is revised by CMS each year?

When the Medicare program does not have primary responsibility for paying a beneficiary's medical expenses, the Medicare __________ concept applies.

A chargemaster team jointly shares the responsibility of updating and revising the chargemaster to ensure its __________.

​A patient is admitted as a hospital inpatient for treatment of acute asthma. The patient also has hypertension, which was medically managed during the inpatient admission. Which present on admission (POA) indicator applies to the acute asthma?

The federal government administers several health care programs, some of which require services to be reimbursed according to predetermined reimbursement methodologies, which are established as __________.

Which is the distribution of financial resources among competing groups?

A patient is admitted as a hospital inpatient with a diagnosis of possible cerebrovascular accident. During admission, the patient falls out of bed fractures her right arm. Which present on admission (POA) indicator applies to the right arm fracture diagnosis?​

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

The MMA of 2003 mandated implementation of a(n) __________ payment amount as a substitute for the Ambulatory Surgical Center (ASC) standard overhead amount for surgical procedures performed at an ASC.

HIPPS codes are determined after home health care patient assessments using the __________ are completed.