Chapter 9

Front 1

An 'episode of care' in the home health prospective payment system (HHPPS) is ..... days

Back 1

60

Front 2

Which type of hospital is excluded from the inpatient prospective payment system?

Back 2

cancer

Front 3

Which is a relative value unit (RVU) in the medicare physician fee schedule payment system?

Back 3

practice expense

Front 4

Medicare part B radiology services payments vary according to

Back 4

place of service

Front 5

The physician fee schedule for CPT code 99214 is $75. Calculate the nonPar limiting charge for this service

Back 5

$81.94

Front 6

The physician fee schedule for CPT code 99214 is $75. Calculare the nonPAR allowed charge for the service.

Back 6

$71.25

Front 7

The intent of establishing a limiting charge for nonPARs is to

Back 7

protect Medicare enrolles financially

Front 8

Which is classfied as a non physician practitioner?

Back 8

physician assistant

Front 9

Which publication communicares new or changes policies and procedures that are being incorporated into a specific CMS manual?

Back 9

program transmittal

Front 10

Which PPS provides a predetermined payment that depends on the patient's principal diagnosis, comorbidities, complications, and principal and secondary procedures?

Back 10

IPPS

Front 11

The chargemaster is a(n)

Back 11

computer-generated list used by facilities, which contains procedures, services, supplies, revenue codes, and charges

Front 12

Resoure utilization groups (RUGs) is a ....... reimbursement methodogy used by skilled nursing facilities.

Back 12

cost-based

Front 13

Which legislated implementation of the long-term (acute) care hospital inpatient prospective payment system?

Back 13

BBRA

Front 14

The resource-based relative value scale (RBRVS) system is more commonly called the .....

Back 14

Medicare physician fee schedule

Front 15

a facility's ....... is a measure of the types of patients treated, and its reflects patient utilization of varying levels of healthcare

Back 15

case mix

Front 16

Disgnosis-related groups are organized into mutually exclusive categories calles......., which os loosely based on body systems.

Back 16

major diagnostic categories

Front 17

Physician work, practice expense, and malpractice expense are componenets in computing .... for the resource-based relative value scale system.

Back 17

relative-value units

Front 18

Four-digit .... codes are preprinted on a facilities's chargemaster to indicate the location or type of service provided to an institutional patient.

Back 18

place of service

Front 19

The type of bill (TOB) is a required element that is entered in FL4 on the UB-04, and it contains ..... digits

Back 19

4

Front 20

RUG

Back 20

skilled nurse

Front 21

DRG

Back 21

IP

Front 22

APC

Back 22

OP

Front 23

RBRVS

Back 23

physician

Front 24

HHRG

Back 24

Home health

Front 25

Ambulance fee schedule

Back 25

payment system for ambulance services provided to medicare beneficiries

Front 26

nonPAR

Back 26

doesn't contract with the insurance plan

Front 27

limiting charge

Back 27

maximum benefit payable to a health plan participant

Front 28

Reimbursment formula

Back 28

base payment rate x DRG wieght