question

Claims for RBRVS physician payments are prepared using__________________ that have associated RVUs.

answer

CPT Codes

question

What are the three elements of the RVU?

answer

Work, PE, Malpractice (MP)

question

In your own words describe how can physician payments be adjusted for the price differences among various parts of the country?

answer

An adjustment component, geographic practice cost index (GPCI), reflects local costs, and the WORK, PE, and MP elements of the RVU have their own GPCIs. Both the RVUs and GPCIs are included in the payment calculation

question

In your own words describe the control mechanism the government uses on Medicare payments to physicians, and how is it applied?

answer

The conversion factor (CF) is the control (constant) CMS raises or lowers annually to adjust physician payments. The sum of RVUs and GPCIs are multiplied by the conversion factor to arrive at the national allowance, 80 percent of which is the actual reimbursement payment (once the Part B deductible is met).

question

In your own words describe how the "two-times rule" is applied to APC groups.

answer

The rule establishes that the median cost of the most expensive procedure or service in the APC cannot be more than two times greater than the median cost of the least expensive procedure or service in the same group.

question

List three adjustments that are used under OPPS to account for cost differences among facilities under OPPS.

answer

Wage index adjustment • Permanent hold harmless add-on payment • Rural sole community hospital add-on payment

question

Explain in your own words why the home health HIPPS code is called an "intelligent" code.

answer

The codes are "intelligent" because the number or letter in each position provides information: • First position: Payment grouping step for episode (numeric characters only) • Second, third, and fourth positions: clinical, functional, and service dimensions, in order (alphabetic characters only) • Fifth position: Severity of nonroutine medical supplies (NSR severity) (alphanumeric characters)

question

All of these services are included in consolidated billing of SNFs except for? laboratory tests x-rays radiation therapy pharmaceuticals

answer

Radiation Therapy

question

How is durable medical equipment (DME) reimbursed in the HHPPS?

answer

ME is excluded from the per-episode HHPPS reimbursement system and is reimbursed under the DME fee schedule.

question

The therapist in the skilled nursing facility is treating multiple patients who are each performing different therapies. How does CMS classify this mode of delivery?

answer

Concurrent

question

All of the following domains are part of the HHPPS case mix except: Medical malpractice Functional status Service utilization Clinical severity

answer

Medical Practice

question

CMS analysts divide SNF admissions into upper and lower categories. Which of the following categories requires the resident's admission to be justified on an individual basis

answer

Reduced Physical Function

question

Which one of the following statements characterizes the RBRVS payment system?

answer

RBRVS payment system reflects the skill and resources required for each procedure.

question

If another status T procedure were performed, how much would the facility receive for the second status T procedure? Billing Number Status Indicator CPT/HCPCS APC 998323 V 99285-25 0612 998323 T 25500 0044 998323 X 72050 0261 998323 S 72128 0283 998323 S 70450 0283

answer

50 percent

question

The HOPPS encompasses a variety of PPSs. All of the following are HOPPS systems EXCEPT:

answer

percent of billed charges

question

All of the following items are packaged under the Medicare Hospital Outpatient Prospective Payment System (HOPPS), EXCEPT for

answer

medical visits

question

Which element of the RVU accounts for the costs of the medical practice, such as office rent, wages of nonphysician personnel, and supplies and equipment?

answer

Practice Expenses

question

What is the maximum number of APCs that may be assigned per encounter?

answer

Unlimited

question

Under the ASC List multiple procedures performed during the same surgical session are reimbursed at which of the following rate?

answer

The procedure in the highest level group receives full payment and the remaining receive half (50%) payment

question

Which university is associated with the development of the RBRVS payment system?

answer

Harvard

question

Which of the following statements is true about APCs? APCs are based solely on the patient's principal diagnosis ICD-9-CM procedure codes are used to group patients Severity of illness is taken into consideration when grouping APCs Correct! APCs are based on the CPT or HCPCS code(s) reported

answer

APCs are based on the CPT or HCPCS code(s) reported

question

Which of the following status indicators indicates that the APC payment is reduced when multiple procedures with this status are reported together? V - medical visit X - ancillary service Correct! T - surgical service S - significant procedure G - pass-through drug

answer

T - surgical service

question

Which of the following sites is considered a facility in the RBRVS payment system?

answer

Ambulance

question

Which researcher is associated with the RBRVS payment system?

answer

Hsaio

question

It is the year 200*. The federal government is determined to lower the overall payments to physicians. To incur the least administrative work, which of the following elements of the physician payment system would the government reduce?

answer

Conversion Factor

question

What is the term for an index based on relative differences in the cost of a market basket of goods across areas?

answer

GPCI

question

A non-participating provider in Medicare agrees to accept assignment.

answer

False

question

PQRS was established to measure physician quality in the delivery of care.

answer

True

question

Pass-throughs are exceptions to the Medicare PPS.

answer

True

question

Modifier 53 is used to report procedures in the HOPPS when a surgery is discontinued for a patient who has been prepared for surgery and taken to the OR but has not been administered anesthesia.

answer

False

question

The Medicare Modernization Act of 2003 mandated the creation of a new PPS for ASC services because:

answer

There is disparity between ambulatory surgical center and hospital outpatient facility payments for the same services

question

This is the standard amount added to the rate for each RUG to cover administrative and capital - related costs.

answer

Non-case - mix- adjusted component

question

Under the SNF PPS, which one of the following healthcare services is excluded from the consolidated payment? Laboratory tests Routine cares Medications Correct! Radiation therapy

answer

Radiation therapy

question

Which classification system is used to case-mix adjust the SNF payment rate?

answer

RUGs

question

What data set provides the underpinning of the HHPPS?

answer

OASIS

question

In the SNF PPS, which data set determines a resident's classification into a resource utilization group?

answer

Minimum Data Set

question

When an HHA provides minimal care reimbursement is adjusted by:

answer

LUPA

question

How many HHRGs are there?

answer

153

question

All of the following services are consolidated into a single payment under the HHPPS except: Home health aide visits Routine and nonroutine medical supplies Correct! Durable medical equipment Nursing and therapy services

answer

Durable medical equipment

question

All of the following dimensions are part of the HHPPS calculation of the case weight except: Clinical severity Functional status Service utilization Correct! Medical malpractice

answer

Medical malpractice

question

The unit of payment in the HHPPS is

answer

Episode of Care

question

What tool does the SNF PPS use annually to adjust payment rate?

answer

Market Basket Index

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