EXAM 1

Question 1

Ambulance service entities associated with a medical facility
• Hospital, CAH, SNF

Answer 1

Ambulance Fee Service Entity – provider

Question 2

Ambulance service entities not associated with a medical facility
• Independent ambulance companies

Answer 2

Ambulance Fee Service Entity – supplier

Question 3

Set of Categories of patients (type and volume) treated by a healthcare organization and representing the complexity of the organizations case load

Answer 3

Case Mix

Question 4

what is the payment if patient dies prior to the ambulance being called?

Answer 4

BLS(Basic Life Support) base rate payment will be paid

Question 5

When was ambulance fee schedule implemented?

Answer 5

April 1, 2002

Question 6

How many MDC categories are there?

Answer 6

25

Question 7

Medical necessity via physician certification must be provided for which type of ambulance transport?

Answer 7

Nonemergency transport

Question 8

What is the basis for labor related share in IPF PPS?

Answer 8

Facilities costs related to payrolls, benefits, and professional fees

Question 9

Add up the total number of CMS Relative Weights and divide by the total number of patients.
123.6651 / 155 = 0.7978

Answer 9

Calculation of case mix index

Question 10

Multiply the “CMS Relative Weight” by the total number of cases (patients) in the MS DRG group.
11.6835 = (0.7789 x 15)

Answer 10

Calculating Total CMS Relative Weight

Question 11

DRGs system was implemented?

Answer 11

October 1, 1983 or 2007

Question 12

Basic life support 
advanced life support - level 1
advanced life support - level 2
specialty care transport 
paramedic als intercept 
fixed wing air ambulance 
rotary wing air ambulance

Answer 12

Ambulance levels of service

Question 13

emergency medical technician provides basic life support, including establishment of a peripheral intravenous line

Answer 13

Basic life support

Question 14

assessment provided by an advanced EMT or paramedic (ALS crew) to determine patient needs and the furnishing of one or more ALS interventions. An ALS intervention is a procedure beyond the scope of an EMT

Answer 14

Advanced life support - level 1

Question 15

administration of at least three different medications or the provision of one or more ALS procedures

Answer 15

Advanced life support - Level 2

Question 16

critically injured or ill patients, the level of interhospital service furnished is beyond the scope of a paramedic; next level care is provided by one or more healthcare professionals in an specialty care area

Answer 16

specialty care transport

Question 17

ALS services provided by an entity that does not provide an ambulance transport

Answer 17

Paramedic ALS intercept

Question 18

flight transport; destination is inaccessible by land vehicle or great distances or other obstacles and the patients condition is not appropriate for BLS or ALS ground transportation

Answer 18

Fixed wing air ambulance

Question 19

Helicopter transport; destination in accessible by land vehicle or great distances or other obstacles and the patients conditions are not appropriate for BLS or ALS ground transportation

Answer 19

Rotary wing air ambulance

Question 20

Uses a limited amount of equipment to perform initial assessments and interventions

Answer 20

First responders

Question 21

Knowledge and skill of a first responder but is also qualified to provide basic emergency medical care in the field, as the minimum staff for an ambulance

Answer 21

EMT

Question 22

Knowledge and skills identified at the first responder and EMT levels but is also qualified to perform essential advanced techniques and to administer a limited number of medications

Answer 22

Advanced EMT

Question 23

Has advanced skills and can administer additional interventions and medications

Answer 23

Paramedic

Question 24

Computer program using specific data elements to assign patients, clients, or residents to group, categories, or classes

Answer 24

Grouper

Question 25

Adjustment for geographic differences in cost
Each RVU category has a corresponding 
Based on “locality” or payment areas
Can be
Large metropolitan area
Boston or San Francisco
Portions of states
Rest-of-state areas
Entire state

Answer 25

GPCI – Geographic practice cost indexes

Question 26

Overhead costs of the practice
Clinical and administrative payroll, office expenses, medical material and supply costs, medical equipment costs
Two PE components: Facility (hospital); Nonfacility (physician office)

Answer 26

Practice expense in RBRVs

Question 27

Time required and intensity of procedure
Mental effort and judgment
Technical skill
Physical effort
Psychological stress

Answer 27

Work expense in RBRVs

Question 28

Assigned to HCPCS codes are a measure of resource utilization
There are 3 RVU categories
Work
PE
MP or PLI

Answer 28

Relative value units

Question 29

[(WORK RVU) (WORK GPCI) + (PE RVU) (PE GPCI) + (MP RVU) (MP GPCI)] = (SUM) × CF = Medicare Physician Fee Schedule (MPFS) Amount

Example: [(0.93) (0.990) + (1.11) (0.917) + (0.08) (1.005)] = (SUM) × $35.9996 = $72.66

Answer 29

RBRVs payment calculation

Question 30

How might a hospital increase their case mix?

Answer 30

create a task force or group of personnel for Clinical Documentation Improvement (CDI). The role of this group is not only to review all physician/clinician documentation for accuracy and to eliminate mistakes and lack of precision that impact billing and payments, but also to create processes that eliminate the most common mistakes made in documentation.

Question 31

How are payment rates established for IPPS?

Answer 31

base payment rate is multiplied by the DRG relative weight.

Question 32

Wage Adjustments - ($771.35 * 0.75 * 0.9716) + ($771.35 * 0.25)
$754.92
Multiply the adjustment factors together
1.17 * 0.99 * 1.10 * 1.06 * 1.05 = 1.4181
1.4181 * $754.92 = $1,070.55 (adjusted per diem amount)
Day 1 1.31 * $1,070.55 = $1,402.42
Day 2 1.12 $1,199.02
Day 3 1.08 $1,156.19
Day 4 1.05 $1,124.08
Day 5 1.04 $1,113.37
Total = $5,995.08

Answer 32

Patient level and facility level adjustments in IPF PPS

Question 33

daily publication of the US federal government that issues proposed and final administrative regulations of federal agencies. Including healthcare common coding systems

Answer 33

Federal register