Ch 17: True and False Flashcards
Reimbursement Procedures: Getting Paid
T/F: Medicare patients are not included in the PPS system
False
T/F: Prospective payment rates are set at a level intended to cover operating costs for treating a typical inpatient in a given DRG
True
T/F: Under Medicare’s PPS, hospitals are paid a set fee for treating patients in a single DRG category, regardless of the actual cost of care for the individual
True
T/F: The established payment rate for all services that a patient in an acute care hospital receives during an entire stay is based on a predetermined payment level that is selected on the basis of averages
True
T/F: The biggest challenge in developing an RVS-based payment schedule was patient diversity
False
T/F: The Affordable Care Act eliminated patient cost-sharing requirements (coinsurance and deductible) for most Medicare-covered preventive services
True
T/F: DRGs are used for reimbursement in the PPS of the Medicare and Medicaid healthcare insurance systems
True
T/F: DRGs adopted by CMS are defined by diagnosis and procedure codes used in the coding manuals
True
T/F: A patient’s DRG categorization depends on the coding and classification of the patient’s medical information using only the CPT coding system
False
T/F: Each DRG is assigned a relative weight (RW) and an average length of stay (ALOS)
True
T/F: When patients are admitted to either a residential healthcare facility or a nursing home, physicians are required to prepare a written plan of care for treatment
True
T/F: Activities of daily living are behaviors related strictly to mental health
False
T/F: Medicare payment rules are established by Congress
False
T/F: The Medicare program is administered mainly at the local and regional level by private insurance companies that contract with CMS to handle day-to-day billing and payment matters
True
T/F: One of the chief objectives in creating the PPS was to monitor the quality of hospital services for Medicare beneficiaries
True