Question 1

Which type of software is used to determine the appropriate HHRG after OASIS data is input on each patient (to measure the outcome of all adult patients receiving home health services) ?

Accepted Answer

A)   calculator
B)   editing
C)   encrypting
D)   grouperE) A) and B)
F) B) and C)

Question 2

A nurse practitioner (NP)  is a registered nurse licensed to practice as an NP in the state in which services are furnished, is certified by a national association (e.g., American Academy of Nurse Practitioners) , and has a(n)  __________ degree in nursing.

Accepted Answer

A)   associate's
B)   bachelor's
C)   master's
D)   doctorate'sE) None of the above
F) A) and C)

Question 3

Reimbursement according to a __________ means that hospitals reported actual charges for inpatient care to payers after discharge of the patients from the hospital.

Accepted Answer

A)   prospective cost-based rate
B)   prospective price-based rate
C)   retrospective reasonable cost system
D)   site-of-service differentialE) A) and C)
F) A) and D)

Question 4

Hospitals that treat unusually costly cases receive increased __________ payments that are designed to protect hospitals from large financial losses due to unusually expensive cases.

Accepted Answer

A)   disproportionate
B)   indirect
C)   outlier
D)   severityE) None of the above
F) B) and C)

Question 5

Which are preprinted on a facility's chargemaster to indicate the location or type of service provided to an inpatient?

Accepted Answer

A)   CPT codes
B)   HCPCS level II codes
C)   ICD-10-CM/PCS codes
D)   Revenue codesE) A) and B)
F) All of the above

Question 6

Approved teaching hospitals receive increased Medicare payments according to a(n)  __________ adjustment.

Accepted Answer

A)   disproportionate share hospital
B)   indirect medical education
C)   risk of inpatient patient mortality
D)   severity of inpatient illnessE) A) and B)
F) B) and C)

Question 7

​A patient is admitted as a hospital inpatient and undergoes appendectomy surgery. The responsible physician documents acute appendicitis. Upon discharge, the patient is provided with instructions for followup and care postoperatively as well as for hyperthyroidism. Which present on admission (POA)  indicator applies to the hyperthyroidism?

Accepted Answer

A)   ​Y (present at the time of inpatient admission) 
B)   ​N (not present at the time of inpatient admission) 
C)   ​U (documentation is insufficient to determine if condition is present on admission) 
D)   ​W (provider is unable to clinically determine whether condition was present on admission or not) E) A) and B)
F) All of the above

Question 8

Each home health resource group (HHRG)  has an associated __________ that increases or decreases Medicare's payment for an episode of home health care.

Accepted Answer

A)   case mix
B)   cost basis
C)   resource utilization
D)   weight valueE) C) and D)
F) B) and C)

Question 9

Which was adopted for one year by Medicare in 2007 to reimburse hospitals for inpatient care provided to Medicare beneficiaries?

Accepted Answer

A)   DRGs
B)   AP-DRGs
C)   APR-DRGs
D)   MS-DRGsE) B) and C)
F) None of the above

Question 10

Which is a facility's measure of the types of patients treated and reflects patient utilization of varying levels of health care resources?

Accepted Answer

A)   case mix
B)   cost basis
C)   discharge status
D)   resource utilizationE) A) and B)
F) A) and C)

Question 11

Home health resource groups are reported to Medicare on UB-04 using the __________ code set, which represents case-mix groups about which payment determinations are made for the home health prospective payment system.

Accepted Answer

A)   CPT
B)   HCPCS level II
C)   HIPPS
D)   ICD-10-CME) A) and B)
F) B) and C)

Question 12

The inpatient prospective payment system (IPPS)  resulted in Medicare reimbursing hospitals for inpatient hospital services according to a __________ rate for each discharge.

Accepted Answer

A)   cost-based
B)   per diem
C)   predetermined
D)   retrospectiveE) All of the above
F) C) and D)

Question 13

Revenue cycle management is the process by which health care facilities and providers ensure their financial viability by increasing __________, improving cash flow, and enhancing the patient's experience.

Accepted Answer

A)   charges
B)   costs
C)   patient satisfaction
D)   revenueE) B) and C)
F) A) and D)

Question 14

Which is the original DRG system adapted for use by third-party payers to reimburse hospitals for inpatient care provided to non-Medicare beneficiaries (e.g., BlueCross BlueShield)  and is based on intensity of resources?

Accepted Answer

A)   DRGs
B)   AP-DRGs
C)   APR-DRGs
D)   MS-DRGsE) A) and D)
F) B) and C)

Question 15

Which is the extent of physiological decompensation or organ system loss of function?

Accepted Answer

A)   case-mix management
B)   intensity of resources
C)   risk of mortality
D)   severity of illnessE) B) and D)
F) A) and D)

Exam 9: Cms Reimbursement Methodologies

Reimbursement according to a __________ means that hospitals reported actual charges for inpatient care to payers after discharge of the patients from the hospital.

Correct Answer
verified

A nurse practitioner (NP) is a registered nurse licensed to practice as an NP in the state in which services are furnished, is certified by a national association (e.g., American Academy of Nurse Practitioners) , and has a(n) __________ degree in nursing.

Correct Answer
verified

Which is the extent of physiological decompensation or organ system loss of function?

Correct Answer
verified

Each home health resource group (HHRG) has an associated __________ that increases or decreases Medicare's payment for an episode of home health care.

Correct Answer
verified

Which was adopted for one year by Medicare in 2007 to reimburse hospitals for inpatient care provided to Medicare beneficiaries?

Correct Answer
verified

Which are preprinted on a facility's chargemaster to indicate the location or type of service provided to an inpatient?

Correct Answer
verified

Which type of software is used to determine the appropriate HHRG after OASIS data is input on each patient (to measure the outcome of all adult patients receiving home health services) ?

Correct Answer
verified

Home health resource groups are reported to Medicare on UB-04 using the __________ code set, which represents case-mix groups about which payment determinations are made for the home health prospective payment system.

Correct Answer
verified

The inpatient prospective payment system (IPPS) resulted in Medicare reimbursing hospitals for inpatient hospital services according to a __________ rate for each discharge.

Correct Answer
verified

Which is the original DRG system adapted for use by third-party payers to reimburse hospitals for inpatient care provided to non-Medicare beneficiaries (e.g., BlueCross BlueShield) and is based on intensity of resources?

Correct Answer
verified

Revenue cycle management is the process by which health care facilities and providers ensure their financial viability by increasing __________, improving cash flow, and enhancing the patient's experience.

Correct Answer
verified

Hospitals that treat unusually costly cases receive increased __________ payments that are designed to protect hospitals from large financial losses due to unusually expensive cases.

Correct Answer
verified

Correct Answer
verified

Which is a facility's measure of the types of patients treated and reflects patient utilization of varying levels of health care resources?

Correct Answer
verified

Approved teaching hospitals receive increased Medicare payments according to a(n) __________ adjustment.

Correct Answer
verified

Exam 9: Cms Reimbursement Methodologies

Reimbursement according to a __________ means that hospitals reported actual charges for inpatient care to payers after discharge of the patients from the hospital.

Correct AnswerverifiedShow Answer

A nurse practitioner (NP) is a registered nurse licensed to practice as an NP in the state in which services are furnished, is certified by a national association (e.g., American Academy of Nurse Practitioners) , and has a(n) __________ degree in nursing.

Correct AnswerverifiedShow Answer

Which is the extent of physiological decompensation or organ system loss of function?

Correct AnswerverifiedShow Answer

Each home health resource group (HHRG) has an associated __________ that increases or decreases Medicare's payment for an episode of home health care.

Correct AnswerverifiedShow Answer

Which was adopted for one year by Medicare in 2007 to reimburse hospitals for inpatient care provided to Medicare beneficiaries?

Correct AnswerverifiedShow Answer

Which are preprinted on a facility's chargemaster to indicate the location or type of service provided to an inpatient?

Correct AnswerverifiedShow Answer

Which type of software is used to determine the appropriate HHRG after OASIS data is input on each patient (to measure the outcome of all adult patients receiving home health services) ?

Correct AnswerverifiedShow Answer

Home health resource groups are reported to Medicare on UB-04 using the __________ code set, which represents case-mix groups about which payment determinations are made for the home health prospective payment system.

Correct AnswerverifiedShow Answer

The inpatient prospective payment system (IPPS) resulted in Medicare reimbursing hospitals for inpatient hospital services according to a __________ rate for each discharge.

Correct AnswerverifiedShow Answer

Which is the original DRG system adapted for use by third-party payers to reimburse hospitals for inpatient care provided to non-Medicare beneficiaries (e.g., BlueCross BlueShield) and is based on intensity of resources?

Correct AnswerverifiedShow Answer

Revenue cycle management is the process by which health care facilities and providers ensure their financial viability by increasing __________, improving cash flow, and enhancing the patient's experience.

Correct AnswerverifiedShow Answer

Hospitals that treat unusually costly cases receive increased __________ payments that are designed to protect hospitals from large financial losses due to unusually expensive cases.

Correct AnswerverifiedShow Answer

Correct AnswerverifiedShow Answer

Which is a facility's measure of the types of patients treated and reflects patient utilization of varying levels of health care resources?

Correct AnswerverifiedShow Answer

Approved teaching hospitals receive increased Medicare payments according to a(n) __________ adjustment.

Correct AnswerverifiedShow Answer

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