Brilliantscores1

1. The nurse is caring for a patient whose insurance coverage is Medicare. The nurse should consider which information when planning care for this patient? a. Capitation provides the hospital with a means of recovering variable charges. b. The hospital will be paid for the full cost of the patient's hospitalization. c. Diagnosis-related groups (DRGs) provide a fixed reimbursement of cost. d. Medicare will pay the national average for the patient's condition. - ANSWE...

estimated payment for MSRDG formula - ANSWERShospitals base rate times the relative weight Case-mix index is an average of the sum of the relative weights (RWs) of all patients treated during a specified time. - ANSWERS19.44 (RW Total) / Total Discharges (15) = 1.296 (Case-Mix Index) A type 1 transfer is when a patient is discharged from an acute care IPPS hospital and is admitted to another acute IPPS hospital on the same day. If a patient leaves an acute IPPS hospital against medical adv...

72-Hour Rule - ANSWERSIt states that if a patient receives any treatment related to the inpatient admission, such as diagnostic labs, x-rays, medical equipment, and any outpatient services within 72 hours of admission to a hospital (3-day payment window), then all such services are bundled with iinpatient service claim if these services are related to the admission AEP :Approiateness Evaluation Protocol - ANSWERSSet of rules about whether a patient should be admitted or kept in the hopsital ...

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. What is the average of the sum of the relative weights of all patients treated during a specified time period? - ANSWERSCase mix index Select the highest level of the IPPS hierarchy: - A...

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 def...

Hospital Inpatient Prospective Payment System - ANSWERSIPPS is a method of payment undertaken by CMS to control the cost of inpatient acute care hospital services to Medicare recipients. DRGs - ANSWERSpayment rates to hospitals established before services are rendered. For fiscal year 2008, Medicare adopted a severity adjusted diagnosis related group system called? - ANSWERSMedicare Severity DRGs (MS-DRGs) The goal of of MS-DRG was? - ANSWERSto significantly improve Medicare's abilit...

How are critical access hospitals paid by Medicare? - ANSWERSCAHs may choose to be paid by Medicare under the "Standard Payment Method" or the "Optional Payment Method" What is the correct POA indicator when the documentation is unclear whether the condition was present on admission and the provider is not available to provide a response? - ANSWERSU ______ is based on claims and documentation filed by the provider using medical diagnosis and procedure codes. - ANSWERSReimbursem...

An additional payment to hospitals that is used to offset the costs of medical education is known as the - ANSWERSindirect medical education adjustment True or False? Over the years, Medicare expenditures have been on the rise because, in the past, Medicare and other payers have reimbursed providers in a retrospective cost-based reimbursement environment. - ANSWERSTrue Under Medicare, liver transplants are considered medically reasonable and necessary for specified conditions when performe...

What payment methodology is used to reimburse inpatient rehabilitation groups? - ANSWERSCase-mix groups Response Feedback: Inpatient rehabilitation hospitals are reimbursed under Case-Mix Groups (CMGs) What payment methodology is used by Medicare to reimburse inpatient acute care hospitals? - ANSWERSMS-DRGs Response Feedback: Inpatient acute care hospitals are reimbursed under MS-DRGs A condition code is defined as: - ANSWERSA two-digit code entered on the claim form to indicate that a...

Covered skilled services of Home Health Agencies do not include: - ANSWERSdoctors' services what reimbursement methodology is used in the LTCH PPS? - ANSWERScase rate Under the SNF PPS what does consolidated billing mean? - ANSWERSSNFs must pay for outpatient services that a resident may receive from outside vendors instead of the vendors submitting their bills to CMS In most situations, for a facility to be defined as an LTCH, the lengths of stay of its Medicare patients must be at ...