Medicare Flashcards
The federal government is the primary purchaser of healthcare services.
True
False
True
Medicare is available only to individuals who are ≥ 65 years of age.
True
False
False
CMs do not need to be knowledgeable about the medical necessity criteria required for Medicare Parts A and B coverage and associated costs.
True
False
False
Hospitals contract with Medicare to furnish acute hospital inpatient care and agree to accept predetermined acute inpatient prospective payment system (IPPS) rates as payment in full.
True
False
True
CMs should always review the patient benefits and deductible amounts to assure patients are provided the most cost-effective care in the right setting.
True
False
True
Consumers are demanding better ways to manage their own health and seek transparency in how they identify healthcare plans and what healthcare costs their plans will cover.
True
False
True
Which of the following is the largest individual purchaser of healthcare in the US?
a) Medicare
b) United Healthcare
c) Humana
d) Medicare Advantage
a)Medicare
All of the following are Federal health insurance plans EXCEPT?
a) CHAMPVA
b) Tricare
c) CHIP
d) Medicare Advantage
d)Medicare Advantage
Which part of Medicare covers both End Stage Renal Disease and Mental Health care costs?
a) Medicare Part A
b) Medicare Part B
c) Medicare Part C
d) Medicare Part D
b) Medicare Part B
This Medicare part is paid for by a tax and does not charge the elderly or disabled a premium?
a) Medicare Part A
b) Medicare Part B
c) Medicare Part C
d) Medicare Part D
a) Medicare Part A
The “All in one” alternative to traditional Medicare is Medicare Part?
a) A
b) B
c) C
d) D
c) C
The purpose of the Prospective Payment System (PPS) designed by CMS is?
a) To ensure case managers are a necessary level of staff for the delivery of patient care
b) To motivate providers to deliver patient care in a cost effective, efficient manner
c) To motivate providers to deliver patient care without over-utilization of services
d) Both B and C are correct
d) Both B and C are correct
To motivate providers to deliver patient care in a cost effective, efficient manner
To motivate providers to deliver patient care without over-utilization of services
Which of the following is an accurate statement about the Inpatient Prospective Payment System (IPPS)?
a) IPPS is a payment system based on a complex calculation derived from the average number of hospital days consumed by each patient included in the calculation
b) IPPS is a payment system based on a DRG (Diagnosis Related Group), a payment based on a complex, weighted calculation of the average number of resources used to treat patients in that group
c) IPPS is a numerical system of weights and measures converted into a formula to reflect average cost of all patient types equally
d) IPPS is a payment system based on average number of patients cared for as inpatients by all hospitals in the US that year
b) IPPS is a payment system based on a DRG (Diagnosis Related Group), a payment based on a complex, weighted calculation of the average number of resources used to treat patients in that group
The relative value or weight representing complexity of the case load assigned to each DRG is called its?
a) CMI (Case Mix Index)
b) RCA (Resource Consumption Algorithm)
c) APCM (Average Patient Caseload Mix)
d) CMC (Case Mix Calculation)
a) CMI (Case Mix Index)
When a patient is discharged one or more days ahead of plan for ongoing care at another facility, how is the hospital reimbursed by Medicare?
a) Medicare pays the full DRG as billed
b) Both the hospital and the ongoing care facility are paid by Medicare
c) The PACT (Post Acute Care Transfer) Rule is applied
d) The pay is divided equally by the two treating entities
c) The PACT (post acute care transfer) rule is applied
