Financial Advocacy: Medicare Flashcards
Who is the largest individual purchaser of healthcare in the U.S.?
A. Commercial insurance companies
B. Medicare
C. Consumers
D. VA
B. Medicare
The federal government is the _____ of healthcare services in America including: Medicare, Medicaid, Department of Defense, Veterans health administration, Children’s health insurance program and Indian Health Service Program.
A. Primary purchaser
B. Utilizer
C. Decider
D. None of the above
A. Primary Purchaser
The Centers for Medicare and Medicaid Services (CMS) manage Medicare and Medicaid, the two major government run insurance programs which guarantee health insurance for qualified individuals who are:
A. Elderly
B. Disabled
C. Low Income
D. All of the above
D. All of the above
Medicare Advantage plans are sometimes called what?
A. All in one plans
B. MA Plans
C. Part C
D. Both B and C
D. Both B and C
True or False: The Indian Health Service (IHS) is responsible for providing federal health services for Native American People, including Alaskan natives.
True.
Which part of Medicare are home health after a hospital or skilled nursing facility stay; skilled nursing facility care and hospice services covered under?
A. Part A
B. Part B.
C. Part C
D. Part D
A. Part A
Where does Medicare part A financing come from?
A. Payroll taxes
B. a 2.9% payroll tax paid by both employees and employers
C. Employers
D. None of the above
B. A 2.9% payroll tax paid by both employees and employers
True or False: Medicare Part C, the Medicare Advantage Program are offered by private companies approved by Medicare.
True
Which method of reimbursement is currently utilized by Medicare?
A. Bundled payments
B. RUGS
C. DRG
D. PPS
D. PPS which stands for perspective payment system. This is based on a predetermined fixed amount.
How is the predetermined fixed amount under PPS derived?
A. based on the classification system of that service such as the diagnosis related groups (DRGs)
B. Global Length of Stay adjustments
C. Lump sum payments
D. ICD 10 coding
A. based on the classification system of that service such as the diagnosis related groups (DRGs)
True or False: The Perspective payment system enables healthcare providers to be aware of the predetermined reimbursement amount for patient care so that they can limit the care and increase profits.
False. The Perspective Payment System enables healthcare providers to be aware of the predetermined reimbursement amount for patient care regardless of the amount of care provided.
Which Payment system is based on a DRG, a payment based on a complex, weighted calculation of the average number of resources used to treat patients in that group?
A. PPS
B. IPPS
C. Bundled
D. None of the above
B. IPPS
What is the Case Mix index?
A. the number of patients allowed in each payor class
B. the payment cap based on the acuity of the patients in the facility
C. relative value assigned to a diagnosis-related group of patients in a medical care environment.
D. None of the above
C. Case Mix Index (CMI) is a relative value assigned to a diagnosis-related group of patients in a medical care environment. The CMI value is used in determining the allocation of resources to care for and/or treat the patients in the group.
What does PACT (Post-Acute Transfers) do to medicare inpatient reimbursement?
A. increases the reimbursement rate when a patient has a shorter length of stay
B. does not affect medicare inpatient reimbursement at all.
C. Bases payment on the national average length of stay for a diagnosis
D. Reduces medicare inpatient reimbursement whenever patients assigned to any of the 280 separate MS-DRGs are discharged to qualifying post-acute care settings more than one day earlier than the national average.
D. PACT (Post-Acute Transfers) reduces Medicare inpatient reimbursement whenever patients assigned to any of the 280 separate MS-DRGs are discharged to qualifying post-acute settings more than one day earlier than the national average.
True or False: In a significant number of cases, patients do not follow the post-hospital transition plan post hospitalization, or an inaccurate discharge status code is assigned to the claim.
True
