Exam 9: Cms Reimbursement Methodologies

Reimbursement according to a __________ means that hospitals reported actual charges for inpatient care to payers after discharge of the patients from the hospital.

Each home health resource group (HHRG) has an associated __________ that increases or decreases Medicare's payment for an episode of home health care.

Hospitals that treat unusually costly cases receive increased __________ payments that are designed to protect hospitals from large financial losses due to unusually expensive cases.

Home health resource groups are reported to Medicare on UB-04 using the __________ code set, which represents case-mix groups about which payment determinations are made for the home health prospective payment system.

Which is a facility's measure of the types of patients treated and reflects patient utilization of varying levels of health care resources?

​A patient is admitted as a hospital inpatient and undergoes appendectomy surgery. The responsible physician documents acute appendicitis. Upon discharge, the patient is provided with instructions for followup and care postoperatively as well as for hyperthyroidism. Which present on admission (POA) indicator applies to the hyperthyroidism?

A nurse practitioner (NP) is a registered nurse licensed to practice as an NP in the state in which services are furnished, is certified by a national association (e.g., American Academy of Nurse Practitioners), and has a(n) __________ degree in nursing.

Which is the extent of physiological decompensation or organ system loss of function?

Which is the original DRG system adapted for use by third-party payers to reimburse hospitals for inpatient care provided to non-Medicare beneficiaries (e.g., BlueCross BlueShield) and is based on intensity of resources?

Approved teaching hospitals receive increased Medicare payments according to a(n) __________ adjustment.

Revenue cycle management is the process by which health care facilities and providers ensure their financial viability by increasing __________, improving cash flow, and enhancing the patient's experience.

Which type of software is used to determine the appropriate HHRG after OASIS data is input on each patient (to measure the outcome of all adult patients receiving home health services)?

Which are preprinted on a facility's chargemaster to indicate the location or type of service provided to an inpatient?

The inpatient prospective payment system (IPPS) resulted in Medicare reimbursing hospitals for inpatient hospital services according to a __________ rate for each discharge.

Which was adopted for one year by Medicare in 2007 to reimburse hospitals for inpatient care provided to Medicare beneficiaries?