Deck 8: Hospital Outpatient Prospective Payment System OPPS

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.

A) HIPPS
B) HCPCS
C) ICD-9-CM
D) APC

Answer 1

B

Question 2

________________ is a category for pass-through devices.

A) Payment Status Indicator H
B) Payment Status Indicator G
C) Payment Status Indicator R
D) Payment Status Indicator S
E) Payment Status Indicator T

Answer 2

A

Question 3

______________________ is for blood and blood products.

A) Payment Status Indicator H
B) Payment Status Indicator G
C) Payment Status Indicator R
D) Payment Status Indicator S
E) Payment Status Indicator T

Answer 3

C

Question 4

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

A) wage index.
B) COLA.
C) base rate.
D) conversion factor.

Question 5

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

A) Best Practices
B) Coding Clinic
C) Federal Register
D) both Best Practices and Coding Clinic
E) None of these is correct.

Question 6

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

A) N
B) S
C) T
D) V
E) X

Question 7

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

A) N
B) S
C) T
D) V
E) X

Question 8

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

A) N
B) S
C) T
D) V
E) X

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.

A) 10%
B) 15%
C) 20%
D) 25%

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.

A) 10
B) 20
C) 30
D) None of these is correct.

Question 11

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

A) start of care.
B) significant changes in condition.
C) death in the hospital.
D) discharge from the HHA.
E) resumption of care after inpatient hospitalization.

Question 12

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

A) HHRG
B) HIPPS
C) APR
D) both HHRG and HIPPS
E) None of these is correct.

Question 13

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

A) three
B) four
C) five
D) six
E) unlimited

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:

A) Partial Episode Payment.
B) Low Utilization Payment.
C) Transfer Type 1.
D) Transfer Type 2.
E) None of these is correct.

Question 15

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

A) Skilled nursing care
B) Routine medical supplies
C) Speech-language pathology
D) All of these are correct.
E) Both skilled nursing care and speech-language pathology

Question 16

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

A) Conversion factor
B) MP
C) Work
D) PE
E) GPCI

Question 17

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

A) Conversion factor
B) MP
C) Work
D) PE
E) GPCI

Question 18

_______________________ is the overhead and costs to operate the practice.

A) Conversion factor
B) MP
C) Work
D) PE
E) GPCI

Question 19

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

A) conversion factor
B) MP
C) Work
D) PE
E) GPCI

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.

Question 21

As with a DRG, an APC will provide multiple payments for comprehensive diagnostic treatments or services that may be reported with multiple HCPCS codes.

Question 22

For the status indicators of S, T, V, and X there is an additional payment made to the provider.

Question 23

New technology APCs were created to allow procedures and services to enter OPPS quickly, even though their complete cost and payment information is not known.

Question 24

Home health agencies provide skilled nursing care to patients that are considered to be homebound. The services include skilled nursing care, physical therapy, occupational therapy, speech therapy, social work, and home health aide services.

Question 25

Typically, a split percentage payment is made to the home care agency. The payments consist of an initial payment and final payment; the initial payment is in response to a Request for Anticipated Payment (RAP) from the home care company.

Question 26

The information is entered, formatted, and transmitted to state agencies. HAVEN software that is available through CMS supports the OASIS data and the transmission. The HAVEN software is mandatory, and some home health agencies have chosen their own software applications for this purpose.

Question 27

For a home care patient being discharged from the hospital, the discharge planning evaluation must be present in the patient's medical record, however, the hospital does not need to discuss the planning process and evaluation with the patient and/or family members.