Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

(cca 2020) > Reimbursement Management > Flashcards

Reimbursement Management Flashcards

DRGs, Medicare and medicaid

1
Q

Which year DRGs shift to MS_DRG?

A

2007

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How much new MS_DRG has been added on 538 DRG?
600
745
550

A

745

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

MDCs has ___ groups

10
20
25

A

25 groups

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the 5 elements that add on payment

On IPPS?

A

DSH disproportionate share hospital
Teaching hospital
New technology
SCH sole community hospital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

HIM and coding section used tool to address old account and high dollars account, which tools they are using?

A

DNFB

discharge not final billed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 3 roles of revenue cycle management?

A

Claim processing
Payment processing
Revenue generation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are 2 factors affect revenue cycle management?

A

Physician productivity

Volume of discharge, admission and transfer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does POA refers to?

A

Present on admission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Purpose of POA?

A

Research
Financial
Quality of care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does HAC stand for?

And HACRP

A

Hospital accuired condition

Rp reduction program

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

HACs list maintained by?

CMS
AHIMA
HHS

A

CMS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Codes of POA?

A 
Y yes
N NOT mentione
W  without Poa
U unknown
I
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What purpose of HACRP?

A

Reduction program by CMS to adjust payment to Healthcare entities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does PTP stand for?

A

Procedure to procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

MUEs stand for?

A

Medically unlikely edites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is maximum number of united billed for single code?

A

MUEs medically unlikely edites

17
Q

MCE stand for?

A

Medicare coding edite

18
Q

What 5 examples of medicare coding edite?

A 
Age conflict
Gender conflict
Non covered
Diagnosis conflict procedures
Procedure with limited coverage
19
Q

NCCI developed by?

A

CMS

20
Q

NCCI APPLY ONLY ON PLAN

A
B
C
D

A

Plan b

21
Q

Insurance plan that covers inpateint care in hospital, critical care and SNF but not long term, hospic care. Benefeceirs must meet certain condition to go

Plan a
Planb
Plan c
Plan d

A

Plan a

22
Q

Type of medicare plan offered by MAC tocover both plan a and b

Plan a
Plan b
Plan c
Plan d

A

Plan c

23
Q

Medicare plan that includes HMO, PPO, FFS, special needs plan

Plan a
Plan b
Plan c
Plan d

A

Plan c

24
Q

Optional and supplemental portion of medicare for which benefeceirs pay monthly premium

Plan a
Plan b
Plan c
Plan d

A

Plan b

25
Q

Medicare plan that covers doctor service and outpatient care,

Plan a
Plan b
Plan c
Plan d

A

Plan b

26
Q

Medicare prescription drug plan

Plan a
Plan b
Plan c
Plan d

A

Plan d

27
Q

Hospitalization that is 5th, 6th of geometric length of stay for long term care diagnosis related group
LTC-DRG

A

Short stay outlier

28
Q

RAC stand for

Rehabilitation administrators committed
Recovery audit contractor
Reimbursement audit contractor

A

Recovery audit contractor

(cca 2020) (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions