Which of the following concepts is a guiding principle for prospective payment? - ANSWERSPayment rates are established in advance of the healthcare delivery and are fixed for the fiscal period to which they apply.
[There are 4 guiding principles of prospective payment: See pg 115
Payment rates ...
HIT 230 Module 6-10 Questions &
Answers
Which of the following concepts is a guiding principle for prospective payment? -
ANSWERSPayment rates are established in advance of the healthcare delivery and are
fixed for the fiscal period to which they apply.
[There are 4 guiding principles of prospective payment: See pg 115
Payment rates are to be established in advance and fixed for the fiscal period to which
they apply
Payment rates are not automatically determined by the hospital's past or current actual
cost.
Prospective payment rates are considered to be payment in full.
The hospital retains the profit or suffers a loss resulting from the difference between the
payment rate and the hospital's cost, creating an incentive for cost control.]
Which piece of legislation called for the first hospital inpatient prospective payment
system? This piece of legislation also allowed some hospital setting to retain their cost-
based payment systems. - ANSWERSTax Equity and Fiscal Responsibility Act (TEFRA)
[The TEFRA of 1982 mandated extensive changes to the Medicare program, and called
for the implementation of a PPS for hospital inpatients.]
What is the average of the sum of the relative weights of all patients treated during a
specified time period? - ANSWERSCase mix index
[The cas mix indes is a weighted average of the sum of the relative weights of all
patients treated during a specified time period.]
Which is the correct formula for IPF wage index adjustment? - ANSWERS(federal
payment rate * labor portion * WI) + (federal payment rate * non-labor portion)
What is the basis of the "labor-related share"? - ANSWERSFacilities' costs related to
payrolls, benefits, and professional fees
In which government publication are the details about the various PPS introduced,
commented on and finalized? - ANSWERSFederal Register
The MS-DRG payment includes reimbursement for all of the following inpatient services
except: - ANSWERSPhysician hospital visit
Mr. Brown was admitted to the hospital with severe chest pains. During his encounter
he underwent a coronary artery bypass procedure (CABG) due to coronary artery
disease (CAD). What is the first step in determining the MS-DRG assignment for this
, encounter? - ANSWERSDetermine if the coronary artery bypass procedure is one of the
Pre-MDC procedures
[See pg 117- Step 1: Pre-MDC assignment.]
What is the general term for software that assigns inpatient diagnosis related groups? -
ANSWERSGrouper
[computer programs that assign patients to case-mix groups are generically called
groupers]
Which IPPS provision is provided to facilities that experience a financial hardship
because they provide treatment for patients who are unable to pay for the services? -
ANSWERSDisproportionate share hospital
Which of the following IPPS provisions provides the hospital with a hospital specific
reimbursement amount? - ANSWERSIndirect medical education &
High cost outlier cases
Which Medicare contractor reimburses acute care hospitals on behalf of Medicare? -
ANSWERSMedicare administrative contractor (MAC)
What is the rate year (RY) for IPPS? - ANSWERSOctober - September
In MS-DRGs, for what is the case-mix index a proxy? - ANSWERSConsumption of
resources
n the IPPS, what is the term for each hospital's unique standardized amount based on
its costs per Medicare discharge? - ANSWERSBase payment rate
A Medicare patient was discharged from one acute IPPS and admitted to another acute
IPPS hospital on the same day. How will the two acute IPPS hospitals be reimbursed? -
ANSWERSThe first hospital receives a per-diem payment derived from the potential
MS-DRG and the second hospital receives the full MS-DRG.
Which reimbursement methodology is used in the Inpatient Psychiatric Facility
Prospective Payment System? - ANSWERSPer diem rate
Which of the following is not a facility-level adjustment under the IPF PPS? -
ANSWERSElectroconvulsive therapy
Within the IPF PPS which of the following statements is true? - ANSWERSThe cost for
psychiatric cases decreases as the length of stay increases
Under the IPF PPS which states are included in the cost of living adjustment (COLA)? -
ANSWERSHawaii and Alaska
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