Heath Insurance Ch. 9

Front 1

HCFA (NOW CMS) IMPLEMENTED THE FIRST PROSPECTIVE PAYMENT SYSTEM (PPS) TO CONTROL THE COST OF HOSPITAL INPATIENT CARE

Back 1

TRUE

Front 2

AN AMULATORY SERGICAL CENTER (ACS) IS FEDERALLY LICENSED, MEDICARE-CERTIFIED SUPPLIER OF SURGICAL HEALTHCARE SERVICES THAT MUST ACCEPT ASSIGNMENT OF MEDICAL CLAIMS

Back 2

FALSE

Front 3

HOSPITAL INPATIENT DEPARTMENTS THAT PERFORM SURGERY ARE REIMBURSED UNDERS OPPS, THE OUTPATIENT PROSPECTIVE PAYMENT SYSTEM

Back 3

FALSE

Front 4

THE MEDICARE DURABLE MEDICAL EQUIPMENT, PROSTHETICS/ORTHOTICS, AND SUPPLIES (DMEPOS) FEE SCHEDULE WAS ESTABLISHED BY THE DEFICIT REDUCTION ACT OF 1984

Back 4

TRUE

Front 5

A VALID ICD9CM DIAGNOSIS CODE MUST BE REPORTED FOR EACH LINE ON THE ELECTRONICALLY SUBMITTED CLAIMS

Back 5

TRUE

Front 6

CPT CODES DIRECTLY AFFECT DRG ASSIGNMENT

Back 6

FALSE

Front 7

DRGs ARE ORGANIZED INTO MUTUALLY EXCLUSIVE CATEGORIES CALLED MAJOR DIAGNOSTIC CATEGORIES (MDCs)

Back 7

TRUE

Front 8

PAYING ACCORDING TO A COMPOSITE RATE IS A COMMON FORM OF MEDICARE PAYMENT, ALSO KNOWN AS UNBUNDLING

Back 8

FALSE

Front 9

A FACILITY'S CASE MIX IS A MEASURE OF THE TYPES OF PATIENTS TREATED, AND IT REFLECTS PATIENT UTILIZATION OF VARYING LEVELS OF HEATHCARE RESOURCES

Back 9

TRUE

Front 10

DECISION TREES ARE USED BY CODERS AND BILLERS TO CALCULATE REIMBURSEMENT

Back 10

FALSE

Front 11

USUALLY COSTLY INPATIENT CASES THAT RECEIVE INCREASED MEDICARE PAYMENTS ARE CALLED OUTLIERS

Back 11

TRUE

Front 12

A MEDICARE ADMINISTRATIVE CONTRACTOR (MAC) IS A THIRD-PARTY PAYER THAT CONTRACTS WITH MEDICARE TO CARRY OUT THE OPERATIONAL FUNCTIONS OF THE MEDICARE PROGRAM

Back 12

TRUE

Front 13

AN OUTPATIENT ENCOUNTER INCLUDES ALL OUTPATIENT PROCEDURES AND SERVICES PROVIDED DURING THE PATIENT'S ENTIRE STAY

Back 13

FALSE

Front 14

APC GROUPER SOFTWARE IS USED TO ASSIGN AN APC TO EACH CPT AND/OR HCPCS LEVEL 2 CODE REPORTED ON AN INPATIENT CLAIM, AS WELL AS REPORT ICD9CM DIAGNOSIS CODES AS APPROPRATE

Back 14

TRUE

Front 15

THE ESRD COMPOSITE PAYMENT RATE SYSTEM BUNDLES ESRD DRUGS AND RELATED LABORATORY WORK WITH THE COMPOSITE RATE PAYMENT

Back 15

TRUE

Front 16

AS PART OF THE DSH ADJUSTMENT, HOSPITALS THAT TREAT A HIGH PERCENTAGE OF LOW-INCOME PATIENTS RECEIVE INCREASED MEDICARE PAYMENTS

Back 16

TRUE

Front 17

THE IPPS FIVE-DAY WINDOW REQUIRES OUTPATIENT PREADMISSION SERVICES PROVIDED BY A HOSPITAL ON THE DAY OF, OR DURING THE FIVE DAYS PRIOR TO A PATIENTS ADMISSION TO BE COVERED BY THE IPPS DRG PAYMENT

Back 17

FALSE

Front 18

EACH CPT AND HCPCS LEVEL 2 CODE IS ASSIGNED A STATUS INDICATOR AS A PAYMENT INDICATOR TO IDENTIFY HOW EACH CODE IS PAID FOR UNDER THE OPPS

Back 18

TRUE

Front 19

IPF PPS IS THE ABBREVIATION FOR INPATIENT PSYCHOLOGICAL FACILITY PROSPECTIVE PAYMENT SYSTEM

Back 19

FALSE