Reimbursement Management Flashcards
DRGs, Medicare and medicaid
Which year DRGs shift to MS_DRG?
2007
How much new MS_DRG has been added on 538 DRG?
600
745
550
745
MDCs has ___ groups
10
20
25
25 groups
What is the 5 elements that add on payment
On IPPS?
DSH disproportionate share hospital
Teaching hospital
New technology
SCH sole community hospital
HIM and coding section used tool to address old account and high dollars account, which tools they are using?
DNFB
discharge not final billed
What are the 3 roles of revenue cycle management?
Claim processing
Payment processing
Revenue generation
What are 2 factors affect revenue cycle management?
Physician productivity
Volume of discharge, admission and transfer
What does POA refers to?
Present on admission
Purpose of POA?
Research
Financial
Quality of care
What does HAC stand for?
And HACRP
Hospital accuired condition
Rp reduction program
HACs list maintained by?
CMS
AHIMA
HHS
CMS
Codes of POA?
Y yes N NOT mentione W without Poa U unknown I
What purpose of HACRP?
Reduction program by CMS to adjust payment to Healthcare entities
What does PTP stand for?
Procedure to procedure
MUEs stand for?
Medically unlikely edites
What is maximum number of united billed for single code?
MUEs medically unlikely edites
MCE stand for?
Medicare coding edite
What 5 examples of medicare coding edite?
Age conflict Gender conflict Non covered Diagnosis conflict procedures Procedure with limited coverage
NCCI developed by?
CMS
NCCI APPLY ONLY ON PLAN
A
B
C
D
Plan b
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
Plan a
Type of medicare plan offered by MAC tocover both plan a and b
Plan a
Plan b
Plan c
Plan d
Plan c
Medicare plan that includes HMO, PPO, FFS, special needs plan
Plan a
Plan b
Plan c
Plan d
Plan c
Optional and supplemental portion of medicare for which benefeceirs pay monthly premium
Plan a
Plan b
Plan c
Plan d
Plan b
Medicare plan that covers doctor service and outpatient care,
Plan a
Plan b
Plan c
Plan d
Plan b
Medicare prescription drug plan
Plan a
Plan b
Plan c
Plan d
Plan d
Hospitalization that is 5th, 6th of geometric length of stay for long term care diagnosis related group
LTC-DRG
Short stay outlier
RAC stand for
Rehabilitation administrators committed
Recovery audit contractor
Reimbursement audit contractor
Recovery audit contractor
