Question 1

An OPPS payment status indicator is assigned to every ________ code, and this indicator identifies whether the service identified by this code is paid under OPPS.

Accepted Answer

HCPCS (Healthcare Common Procedure Coding System) codes are used in the outpatient setting, and an OPPS (Outpatient Prospective Payment System) payment status indicator is assigned to each HCPCS code to identify if the service is paid under OPPS.

Question 2

________________ is a category for pass-through devices.

Accepted Answer

A

Question 3

______________________ is for blood and blood products.

Accepted Answer

Payment Status Indicator R is used for blood and blood products in the context of medical billing and coding.

Question 4

Payment rates for APCs, outside of drugs and biologicals, are products of the relative weight of the APC and the OPPS:

Accepted Answer

The conversion factor is used to calculate payment rates for APCs, outside of drugs and biologicals, based on the relative weight of the APC and the OPPS.

Question 5

Healthcare facilities need to make sure that they are following ________________________ to ensure that all HCPCS codes are consistent in their descriptions.

Accepted Answer

Healthcare facilities follow both Best Practices and the Coding Clinic guidelines to ensure consistency in HCPCS code descriptions. Best Practices provide a framework for efficient and accurate coding, while the Coding Clinic offers official guidance on the application of HCPCS codes.

Question 6

Payment status indicator _________ is where there is no reimbursement under OPPS.

Accepted Answer

Status indicator "N" signifies items and services that are packaged into the payment for another service and thus have no separate payment under the Outpatient Prospective Payment System (OPPS).

Question 7

Payment status indicator _________ is for significant procedures that do not involve multiple procedure reductions.

Accepted Answer

Payment status indicator "S" is used for significant procedures that do not involve multiple procedure reductions.

Question 8

Payment status indicator _________ is for surgical procedures where multiple procedure reductions apply.

Accepted Answer

The payment status indicator "T" is used for surgical procedures where multiple procedure reductions apply. This means that when multiple procedures are performed during the same surgical session, the payment for some of those procedures may be reduced because they are bundled together for billing purposes.

Question 9

OPPS has frozen the outpatient hospital coinsurance at _________ of the national median charge for the services within each APC, but the coinsurance amount for an APC cannot be less than this percentage of the APC payment rate.

Accepted Answer

OPPS has frozen the outpatient hospital coinsurance at 20% of the national median charge for the services within each APC. This measure ensures that the coinsurance amount for an APC cannot be less than 20% of the APC payment rate, aiming to make healthcare costs more predictable and manageable for patients.

Question 10

The certification must state that a face-to-face encounter took place within 90 days prior to the start of home care or within _____ days after the start of care. The patient must be considered to be confined to their home environment and in need of intermittent care.

Accepted Answer

The certification must state that a face-to-face encounter took place within 90 days prior to the start of home care or within 30 days after the start of care, ensuring the patient's need for home-based care is timely and accurately documented.

Question 11

The OASIS data are collected at all of the following times, except:

Accepted Answer

OASIS (Outcome and Assessment Information Set) data are collected by home health agencies at various points in care, including start of care, significant changes in condition, discharge, and resumption of care after hospitalization, but not at the time of death in the hospital.

Question 12

In the home health prospective payment system, the resource groups are called ____________ instead of DRGs.

Accepted Answer

The resource groups in the home health prospective payment system are called Home Health Resource Groups (HHRG), which are used to determine payment rates.

Question 13

There are ________ positions in the alphanumeric home health HIPPS codes.

Accepted Answer

The alphanumeric home health HIPPS (Health Insurance Prospective Payment System) codes consist of five positions. These codes are used in the Medicare system to classify various types of care, services, and patient conditions to determine reimbursement rates.

Question 14

If a home health agency provides four visits or less in an episode, they will be paid a standardized per visit payment instead of an episode payment for a 60-day period, which is referred to as a:

Accepted Answer

This is known as a Low Utilization Payment Adjustment (LUPA). When a home health agency provides four or fewer visits during a 60-day episode of care, they receive a per-visit payment instead of the full episode payment.

Question 15

Which of the following types of service are subject to the home health consolidated billing provision?

Accepted Answer

The home health consolidated billing provision encompasses all of these services: skilled nursing care, routine medical supplies, and speech-language pathology, indicating that all of these are correct. This provision requires that billing for these services be consolidated, typically under the home health agency responsible for providing or coordinating the patient's care.

Question 16

________________________ means that the payment is based on the payment locality.

Accepted Answer

GPCI stands for Geographic Practice Cost Index, which adjusts payments based on the cost of living and running a practice in different geographic locations. This means the payment is indeed based on the payment locality.

Question 17

______________ is the component that covers the physician's salary.

Accepted Answer

The "Work" component of the Medicare Physician Fee Schedule is designed to cover the physician's time, skill, and effort, which includes their salary.

Question 18

_______________________ is the overhead and costs to operate the practice.

Accepted Answer

PE, or Practice Expense, refers to the overhead and costs associated with operating a medical practice. This includes rent, utilities, medical supplies, and non-physician staff salaries.

Question 19

The ____________________ is an across-the-board multiplier that is a constant that applies to the entire calculation into a payment.

Accepted Answer

The conversion factor is an across-the-board multiplier used in various calculations, including payment calculations, where it applies uniformly to the entire calculation.

Question 20

Each HCPCS code is assigned to only one Ambulatory Payment Classification (APC), however there can be an unlimited number of APCs per encounter for a single beneficiary.

Accepted Answer

HCPCS codes are used to represent services and procedures for billing purposes, and each code is typically assigned to one APC for payment determination. However, during a single encounter, a beneficiary may receive multiple services, each potentially falling under a different APC, thus allowing for multiple APCs per encounter.

Quiz 8: Hospital Outpatient Prospective Payment System OPPS