Prospective Payment Systems

Question 1

PPS model: acute/inpatient care

Answer 1

inpatient prospective payment system (IPPS)

Question 2

PPS model: SNF/Medicare A

Answer 2

patient-driven payment model (PDPM)

Question 3

PPS model: inpatient rehab facilities (IRF)

Answer 3

IRF PPS

Question 4

PPS model: home health

Answer 4

patient-driven groupings model (PDGM)

Question 5

PPS model: outpatient/Medicare Part B

Answer 5

MPFS/”Medicare allowable” (Medicare Physician Fee Schedule)

Question 6

Class. System/Case Mix Group: acute/inpatient care hospitals

Answer 6

diagnosis-related group (DRG)

Question 7

Class. System/Case Mix Group: SNF/Medicare A

Answer 7

PT/OT/SLP/Nursing/NTA;
functional status;
presence of cognitive impairment

Question 8

Class. System/Case Mix Group: inpatient rehab facilities

Answer 8

clinical characteristics;
anticipated resource needs

Question 9

Class. System/Case Mix Group: home health

Answer 9

home health resource groups (153)

Question 10

Class. System/Case Mix Group: outpatient/medicare B

Answer 10

service provided (CPT codes; RBRVS/RVUs)

Question 11

Pt. Assessment Tool: acute/inpatient care hospitals

Answer 11

continuity assessment record & evaluation (CARE) item set

Question 12

Pt. Assessment Tool: SNF-Medicare A

Answer 12

Minimum Data Set 3.0 (MDS 3.0) Section GG

Question 13

Pt. Assessment Tool: inpatient rehab facilities

Answer 13

Inpatient Rehab Facility Patient Assessment Instrument (IRF PAI);
Functional Independence Measure (FIM)

Question 14

Pt. Assessment Tool: home health

Answer 14

Outcome & Assessment Information Set (OASIS)

Question 15

Pt. Assessment Tool: outpatient/Medicare B

Answer 15

alternative payment models (APM) =
Merit Based Incentive Payment System (MIPS);
Advanced APMs