Acute Care: Inpatient Prospective Payment System (IPPS) Questions With Correct Answers
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Course
Acute Care
Institution
Acute Care
What are the steps of the Inpatient Prospective Payment System - ANSWERS1. Establish Per d/c payment/Diagnosis Related Group (DRG)
2.DRG is them weighted based on numerous factors
Who falls under the Inpatient Prospective Payment System - ANSWERSOnly for patient who meet requirements for inpat...
Acute Care: Inpatient Prospective
Payment System (IPPS) Questions With
Correct Answers
What are the steps of the Inpatient Prospective Payment System - ANSWERS1.
Establish Per d/c payment/Diagnosis Related Group (DRG)
2.DRG is them weighted based on numerous factors
Who falls under the Inpatient Prospective Payment System - ANSWERSOnly for patient
who meet requirements for inpatient level of care (severity of illness and intensity of
service)
What happens to this that don't meet the requirements for inpatient? - ANSWERSThose
patients who do not meet level of care as defined by CMS are considered outpatients
and therefore not covered by Medicare Part A (e.g.., observation status, extended
recovery, emergency room)
Between Days 1-60 how much does Medicare pay? How much is your deductible? -
ANSWERS-100% after deductible
- $1,408
Between Days 61-90 how much does Medicare pay after co-payment? How much is
your copayment? - ANSWERS-100% after copayment
-$352/day for co-insurance
For the 60 Reserve Days how much does Medicare pay? How much is your
copayment? - ANSWERS-100% after copayment
-$704/day co-insurance
How much does Medicare cover after 150 days? How much does the Beneficiary Pay? -
ANSWERS-0%
-100%
In regards to a Psychiatric Hospital how much does Medicare Pay? How much is the
Beneficiary Responsible for after 190 days? - ANSWERS-Same as hospital inpatient
(see above) with a 190-day lifetime limit
-100% after 190 days
What factors Determine Hospital Payments? - ANSWERS-Dx
-Comorbidites
-Complications
-Procedures
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