HIM 478 RHIA REVIEW QUESTIONS CHAPTER 7 Flashcards
Based on CMS’s DRG system, other systems have been developed for payment purposes. The one that classifies the non-Medicare population, such as HIV patients, neonates, and pediatric patients, is known as
A. IR-DRGs
B. APR – DRGs
C. RDRGs
D. AP-DRGs
APR – DRGs
Which of the following best describes the situation of a provider who agrees to accept assignment for Medicare Part B services?
A. The provider is paid according to the Medicare Physician Fee Schedule (MPFS) plus 10%.
B. The provider is reimbursed at 15% above the allowed charge.
C. The provider is a nonparticipating provider.
D. The provider cannot bill the patients for the balance between the MPFS amount and the total charges.
the provider cannot bill the patients for the balance between the MPFS amount and the total charges.
A patient with Medicare is seen in the physician’s office.
The total charge for this office visit is $250.00.
The patient has previously paid his deductible under Medicare Part B.
The PAR Medicare fee schedule amount for this service is $200.00.
The nonPAR Medicare fee schedule amount for this service is $190.00.
If this physician is a participating physician who accepts assignment for this claim, the total amount of the patient’s financial liability (out-of-pocket expense) is
a. $30.00.
b. $160.00.
c. $200.00.
d. $40.00.
$40.00
The Centers for Medicare and Medicaid Services (CMS) will make an adjustment to the MS-DRG payment for certain conditions that the patient was not admitted with, but were acquired during the hospital stay. Therefore, hospitals are required to report an indicator for each diagnosis. This indicator is referred to as
A. a sentinel event
B. payment status indicator
C. present on admission
D. a hospital acquired condition
present on admission
A HIPPS (Health Insurance Prospective Payment System) code is a five-character alphanumeric code. A HIPPS code is used by home health agencies (HHA) and ____.
A. ambulary surgery centers (ASC) and physical therapy centers.
B. physical therapy centers and inpatient rehabilitation facilities (IRFs)
C. ambulatory surgery centers (ASC) and skilled nursing facilities (SNFs)
D. skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs)
skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs
A Medicare Summary Notice (MSN) is sent to ________ as their EOB.
A. physicians
B. Skilled nursing facilities
C. patients (beneficiaries)
D. hospitals
patients (beneficiaries)
In the APC system, a high-cost outlier payment is paid when which of the following occurs?
A. The cost of the service is greater than the APC payment by a fixed ratio and exceeds the APC payment plus a threshold amount
B. The LOS is greater than expected
C. The charges for the services provided are greater than the expected payment
D. The total cost of all the services is greater than the sum of APC payments by a fixed ratio and exceeds the sum of APC payments plus a threshold amount.
The cost of the service is greater than the APC payment by a fixed ratio and exceeds the APC payment plus a threshold amount
In the HHPS system, which home healthcare services are consolidated into a single payment to home health agencies?
A. Home health aide visits, routine, and nonroutine medical supplies, durable medical equipment
B. Routine and nonroutine medical supplies, durable medical equipment, medical social services
C. Nursing and therapy services, routine and nonroutine medical supplies, home health aide visits
D. Nursing and therapy services, durable medical equipment, medical social services
Nursing and therapy services, routine and nonroutine medical supplies, home health aide visits
Under RBRVs, which elements are used to calculate a Medicare payment?
A. Work value and extent of the physical exam
B. Malpractice expenses and detail of the patient history
C. Work value and practice expenses
D. Practice expenses and review of systems
Work value and practice expenses
The financial manager of the physician group practice explained that the healthcare insurance company would be reimbursing the practice for its treatment of the exacerbation of congestive heart failure that Mrs. Zale experienced. The exacerbation, treatment, and resolution covered approximately five weeks. The payment covered all the services that Mrs. Zale incurred during the period. What method of reimbursement was the physician group practice receiving?
A. traditional
B. episode of care
C. per diem
D. fee for service
episode of care
For Medicare patients, how often must the home health agency’s assessment and care plan be updated?
A. At least every 60 days or as often as the severity of the patient’s condition requires
B. Every 30 days
C. As often as the severity of the patient’s condition requires
D. Every 60 days
At least every 60 days or as often as the severity of the patient’s condition requires
