CMS reimbursement Flashcards
CMS
center for medicaid and medicare services
How much did medicare cost in 1966
$3 billion
How much did congress think medicare would cost by 1990?
$12 billion
How much did medicare actually cost in 1990?
$107 billion
Who signed medicare and medicaid into law?
Lyndon B. Johnson
PPS
Prospective Payment System
How is Impatient paid for
Pays hospital per discharge
How is outpatient paid for
Pays hospital per service
How are physicians paid
pays doctor per service
How are skilled nursing facility paid
Pays skilled nursing facilities per day
What are the CMS payment systems
-CHAMPVA
-Indian Health Service (IHS)
-Medicaid (also SCHIP)
-Medicare
-TRICARE
-Workers Compensation
ASC
Ambulatory Surgery Center
Home Health
Approve reimbursement rates for 60 days
Hopsital Inpatient
Based on diagnosis; Diagnosis-Related Group (DRG)
Hospitals that treat a high % of low-income patients…?
receive high Medicare patients
T/F: Approved teaching hospitals receive higher medicare payment
True
HAC
Hospital-Acquired conditions
Hospitals are required to submit info on medicare claims whether diagnoses were POA since when?
October 1st 2007
DSM V
The Diagnostic and Statistical
Manual of Mental Disorders
Acute care thats 25 days or longer
Long-term (acute) care Hospital
What are RVU’s
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)
CMS manual system is IOM
IOM- internet-only manual
