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Health Insurance

HI chp 9

QuestionAnswer
What is the payment system for Outpatient PPS? APC-Ambulatory Payment Classification
What is the payment system for Inpatient PPS? MS DRG's-Medicare Severity Diagnosis Related Groups
What is the payment system for Skilled Nursing Facilities? RUG-Resource Utilization Group
Name the adjustments that qualifying hospitals can receive under the IPPS. DSH, Outlier, and IME
What is a state-licensed, Medicare certified supplier of surgical healthcare services that must accept assignment on claims? ASC-Ambulatory Surgical Center
What are MS DRGs organized into? MDC-Major Diagnostic Categories
What is it called when NPP's can bill services provided to Medicare beneficiaries to Medicare directly, which means their services are billed under a supervising physician? Incident To
In the Inpatient PPS, what is assigned to each diagnosis to differentiate between conditions present on admission and those that develop during the hospital stay? POA-Present on Admission
How does Medicare reimburse laboratory services? Either on submitted charge, national limitation amount, or local fee schedule amount, whichever is lowest.
How does Medicare reimburse DMEPOS? Either 80% of the actual charge amount or the fee schedule amount, whichever is lowest.
Medicare reimburses physician's services based on Relative Value Units assigned to each service/procedure. What does this consist of? Physician work expense, practice expense, and malpractice expense (malpractice insurance expense).
What are the patient assessments used in Home Health PPS? OASIS-Outcomes and Assessments Information Sets
What does Medicare call the EOB? MSN-Medicare Summary Notice
What is the process by which healthcare facilities and providers ensure their financial viability by increasing revenue, improving cash flow, and enhancing the patient's experience? Revenue Cycle Management
Created by: YTIMBC
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