Exam 9: Cms Reimbursement Methodologies

Inpatient rehabilitation facilities use __________ software for computerized data entry to create a file in a standard format that can be electronically transmitted to a national database.

The ambulance fee schedule payment system replaced a __________ for providers and suppliers of ambulance services.

An employer group health plan (EGHP) is contributed to by an employer or employee pay-all plan and provides coverage to employees and dependents without regard to the enrollee's employment status. EGHP provisions are applicable __________.

Which is associated with a particular category of patient and is established by the payer prior to the provision of health care services?

Resource allocation monitoring uses data __________ to measure whether a health care provider or organization achieves operational goals and objectives within the confines of the distribution of financial resources.

Medicare reimburses laboratory services according to a(n) __________, which is based on the submitted charge, national limitation amount, or local fee schedule amount, whichever is lowest.

When office-based services are performed in a facility, such as a hospital or outpatient setting, payments are reduced because the doctor did not provide supplies, utilities, or the costs of running the facility. This is known as the __________ differential.

Revenue cycle monitoring involves assessing the revenue cycle to ensure __________ stability using standards of measurement (e.g., cash flow).

Which includes all outpatient procedures and services provided during one day to the same patient?

Which replaced the reasonable cost-based payment system for long-term (acute) care hospitals?

Chargemaster __________ is the process of updating and revising key elements of the chargemaster to ensure accurate reimbursement.

Institutional and other selected providers submit __________ claim data to payers for reimbursement of patient services.

Home Assessment Validation and Entry (HAVEN) __________ software is then used to collect OASIS assessment data for transmission to state databases.

Charging write-off or adjustment amounts to beneficiaries is called __________, and it is prohibited by Medicare regulations.

DRG reimbursement rates are recalculated according to a(n) __________ adjustment, which results in increased Medicare payments for hospitals that treat a high percentage of low-income patients.

A clinical nurse specialist (CNS) is a(n) __________ practice registered nurse licensed by the state in which services are provided, has a graduate degree in a defined clinical area of nursing from an accredited educational institution, and is certified.

A physician assistant (PA) must be legally authorized and licensed by the state to furnish services, have graduated from an accredited physician assistant educational program, and have passed the national certification examination of the __________.

Physician services standardized to measure the value of a service as compared with other services provided are called __________, and they consist of physician work, practice expense, and malpractice expense payment components.

Diagnosis-related groups are organized into mutually exclusive categories called __________, which are loosely based on body systems.

Which are databases that use reporting interfaces to consolidate multiple databases, allowing reports to be generated from a single request?