CH 9 – Assignment Writing – Flashcards
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HCFA (now CMS) implemented the first prospective payment system (PPS) to control the cost of hospital inpatient care.
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True
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An ambulatory surgical center (ACS) is a federally-licensed, Medicare-certified supplier of surgical health care services that must accept assignment of Medical claims.
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False
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Hospital inpatient departments that perform surgery are reimbursed under OPPS, the outpatient prospective payment system.
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False
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The Medicare durable medical equipment, prosthetics/orthotics, and supplies (DMEPOS) fee schedule was established by the Deficit Reduction Act of 1984.
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True
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A valid ICD-9-CM diagnosis code must be reported for each line item on electronically-submitted claims.
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True
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CPT codes directly affect DRG assignment.
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False
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DRGs are organized into mutually exclusive categories called major diagnostic categories (MDCs).
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True
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Paying according to a composite rate is a common form of Medicare payment, also known as unbundling.
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False
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A facility's case mix is a measure of the types of patients treated, and it reflects patient utilization of varying levels of health care resources.
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True
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Decision trees are used by coders and billers to calculate reimbursement.
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False
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Hospitals that treat unusually costly cases and receive increased Medicare payments are called outliers.
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True
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A Medicare administrative contractor (MAC) is a third-party payer that contracts with Medicare to carry out the operational functions of the Medicare program.
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True
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An outpatient encounter includes all outpatient procedures and services provided during the patient's entire stay.
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False
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APC grouper software is used to assign an APC to each CPT and/or HCPCS Level II code reported on an inpatient claim, as well as to report ICD-9-CM diagnosis codes as appropriate.
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False
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The Medicare physician fee schedule (MPFS) reimburses providers according to predetermined rates assigned to services and is revised by CMS each year.
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True
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What does the acronym SOI stand for? A. shortness of intake B. severity of illness C. signature of insured D. none of the above
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B. Severity of illness
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What does the acronym ROM stand for? A. risk of mortality B. review of motion C. review of modality D. risk of morbidity
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A. Risk of mortality
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Reimbursement according to a ____ means that hospitals reported actual charges for inpatient care to payers after discharge of the patients from the hospital. A. prospective price-based rate B. payment system C. prospective cost-based rate D. retrospective reasonable cost system
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D. retrospective reasonable cost system
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Which of the following is a federal health care program? A. CHAMPVA B. Indian Health Service C. Medicaid D. all of the above
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D. All of the above
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Which is a predetermined reimbursement methodology? A. prospective payment system B. prospective price-based rate C. prospective cost-based rate D. retrospective reasonable cost system
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A. prospective Payment system
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What is the name of the payment system for ambulance services provided to Medicare beneficiaries? A. travel-based payment system B. ambulance fee schedule C. reasonable cost fee schedule D. none of the above
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B. Ambulance fee schedule
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Which of the following is a level of ambulance services? A. ground/land transportation B. water transportation C. air ambulance transportation D. all of the above
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D. All of the above
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____ is a data set based on local fee schedules for outpatient clinical diagnostic laboratory services. A. deficit reduction act B. ambulatory outpatient center rate C. clinical laboratory fee schedule D. pathology diagnostic fee schedule
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C. Clinical laboratory fee schedule
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Medicare reimburses laboratory services according to A. local fee schedule amount B. national limitation amount C. submitted charge D. all of the above
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D. all of the above
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A facility's ____ is a measure of the types of patients treated, and it reflects patient utilization of varying levels of health care resources. A. case mix B. composite mix C. discharge assessment D. patient day sheet
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A. case mix
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Long-term acute care hospitals are defined by Medicare as having an average inpatient length stay of greater than A. 30 days B. 15 days C. 25 days D. 10 days
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C. 25 days
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The ____ reimburses providers according to predetermined rates assigned to services and is revised by CMS each year. A. medicare relative value units B. medicare physician fee schedule C. medicare value fee schedule D. medicare resource-based fee schedule
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B. Medicare physician fee schedule
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Medicare is always a secondary payer when a Medicare beneficiary also has coverage from which of the following groups: A. Workers' compensation B. Veterans' Administrative benefits C. automobile medical or no-fault insurance D. all of the above
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D. all of the above
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Which of the following information is necessary to calculate the amount of Medicare secondary benefits payable on a given claim? A. amount paid by the primary payer B. physician's fee schedule C. primary payer's allowable charge D. both A and C
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D. both a and c
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The ____ is a document that contains a computer-generated list of procedures, services, and supplies with charges for each. A. chargemaster B. charge description master C. physician's fee schedule D. both A and B
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both a and b
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The ESRD composite payment rate system bundles ESRD drugs and related laboratory work with the composite rate payment.
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true
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As part of the DSH adjustment, hospitals that treat a high percentage of low-income patients receive increased Medicare payments.
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true
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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 patient's admission to be covered by the IPPS DRG payment.
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false
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Each CPT and HCPCS level II code is assigned a status indicator as a payment indicator to identify how each code is paid for under the OPPS.
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true
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IPF PPS is the abbreviation for inpatient psychological facility prospective payment system.
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false
