Deck 7: Medicare Prospective Payment Systems

Question 1

____________________ is designed for an acute care inpatient setting, and the single payment does not include payment for any professional services that are provided during the patient's hospital stay.

A) IPPS
B) IPF PPS
C) IRF PPS
D) Both IPPS and IRF PPS
E) All of these are correct.

Answer 1

A

Question 2

__________ is made up of a labor-related share or portion and a nonlabor-related share or portion.

A) Relative weight
B) Base rate
C) Case mix
D) Relative value units

Answer 2

B

Question 3

The regulations surrounding the calculation of this additional payment to hospitals are to offset the costs of medical education, known as the:

A) indirect medical education adjustment.
B) disproportionate share adjustment.
C) cost of living adjustment.
D) high-cost outlier adjustment.
E) transfer case adjustment.

Answer 3

A

Question 4

In _________________________, a transfer between IPPS hospitals, the transferring hospital will be paid a per diem rate for the days that the patient spends at the facility.

A) Transfer Type 1
B) Transfer Type 2
C) Transfer Type - special payment transfer
D) None of these is correct.

Question 5

________________________ is a transfer that takes place between a hospital and a facility that is excluded from IPPS.

A) Transfer Type 1
B) Transfer Type 2
C) Transfer Type - special payment transfer
D) None of these is correct.

Question 6

After transplantation, all physician services rendered to the transplant recipient are billed to the _____________________ with all other services during the stay.

A) Medicaid program
B) commercial insurance program
C) Medicare program
D) None of these is correct.

Question 7

__________________________ covers all immunosuppressive drugs following a covered transplant in an approved facility based on the Criteria for Medicare Coverage of Heart Transplants.

A) Medicare Part D
B) Medicare Part C
C) Medicare Part A
D) Medicare Part B

Question 8

Medicare does not cover:

A) ventricular assist devices.
B) transplants in an approved facility.
C) artificial hearts.
D) both ventricular assist devices and artificial hearts.

Question 9

If kidney and pancreas transplants are performed simultaneously, the claim should contain:

A) a diabetes diagnosis code.
B) a renal failure diagnosis code.
C) a hypertensive renal failure diagnosis code.
D) A diabetes diagnosis code, a renal failure diagnosis code, and a hypertensive renal failure diagnosis code.
E) only a diabetes diagnosis code and a hypertensive renal failure diagnosis code.

Question 10

________________ are a specific patient condition that is secondary to a patient's principle diagnosis.

A) Complications
B) Comorbidities
C) Outliers
D) Transfers

Question 11

The IRF must have one physician who serves as the Director of Rehabilitation who:

A) works full-time.
B) is a doctor of medicine or doctor of osteopathy.
C) has completed the 1-year hospital internship and has at least 2 years of training.
D) All of these are correct.
E) None of these is correct.

Question 12

During the stay, the patient must receive close medical attention and have at least ________ face-to-face visits per week by a licensed physician with specialized training in rehabilitative medicine.

A) two
B) three
C) four
D) five

Question 13

An IRF PPS payment is calculated by the ______________________ code assigned to the patient-a five-character alphanumeric code that encompasses the information about the case-mix group and comorbidity.

A) HIPPS
B) HOPPS
C) HHRG
D) HH PPS

Question 14

In 1982, the United States Congress required the creation of a prospective payment system (PPS) to be developed with a focus on controlling costs.

Question 15

There are two methods of qualification for a hospital to become a DSH facility. First, a hospital may qualify for DSH status if they exceed 15% on the statutory formula. The second method for DSH qualification applies to large urban hospitals that may have a high mix of Medicaid or low-income patients.

Question 16

The Cost-to-Charge Ratio (CCR) is applied to the covered charges for a case to determine whether the costs of a case exceed the fixed-loss outlier threshold.

Question 17

The incentive for Medicare to use the transfer policy is to avoid paying the full amount to two facilities for the same patient stay.

Question 18

In the transfer process, to determine the per diem rate, the facility will: take the total cost, divide it by the Geometric Mean Length of Stay (GMLOS), multiply by the total days spent at the transferring facility, and then add one.

Question 19

In a Transfer Type 2, the transferring facility is paid for the full admission, and any outlier calculations will apply for the full admission. The receiving facility will receive payment based on the type of payment system that the facility falls under in the Medicare payment system.

Question 20

A hospital that performs transplant surgery may not acquire cadaver kidneys by excising them from cadavers located in its own hospital. They must accomplish this through arrangements with a freestanding organ procurement organization (OPO) that provides cadaver kidneys to any transplant hospital.