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Medical Terminology > CMS reimbursement > Flashcards

CMS reimbursement Flashcards

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USMLE® Step 1 flashcards
1
Q

CMS

A

center for medicaid and medicare services

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2
Q

How much did medicare cost in 1966

A

$3 billion

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3
Q

How much did congress think medicare would cost by 1990?

A

$12 billion

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4
Q

How much did medicare actually cost in 1990?

A

$107 billion

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5
Q

Who signed medicare and medicaid into law?

A

Lyndon B. Johnson

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6
Q

PPS

A

Prospective Payment System

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7
Q

How is Impatient paid for

A

Pays hospital per discharge

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8
Q

How is outpatient paid for

A

Pays hospital per service

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9
Q

How are physicians paid

A

pays doctor per service

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10
Q

How are skilled nursing facility paid

A

Pays skilled nursing facilities per day

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11
Q

What are the CMS payment systems

A

-CHAMPVA
-Indian Health Service (IHS)
-Medicaid (also SCHIP)
-Medicare
-TRICARE
-Workers Compensation

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12
Q

ASC

A

Ambulatory Surgery Center

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13
Q

Home Health

A

Approve reimbursement rates for 60 days

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14
Q

Hopsital Inpatient

A

Based on diagnosis; Diagnosis-Related Group (DRG)

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15
Q

Hospitals that treat a high % of low-income patients…?

A

receive high Medicare patients

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16
Q

T/F: Approved teaching hospitals receive higher medicare payment

A

True

17
Q

HAC

A

Hospital-Acquired conditions

18
Q

Hospitals are required to submit info on medicare claims whether diagnoses were POA since when?

A

October 1st 2007

19
Q

DSM V

A

The Diagnostic and Statistical
Manual of Mental Disorders

20
Q

Acute care thats 25 days or longer

A

Long-term (acute) care Hospital

21
Q

What are RVU’s

A

how much they pay a physician and the following are taken into consideration:
-Physician work (time, intensity, skill)
– Practice expense (overhead costs)
– Malpractice expense (cost of liability insurance)

22
Q

CMS manual system is IOM

A

IOM- internet-only manual

Medical Terminology (26 decks)

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