CIC - CHAPTER 13 –
EXAm(solved &
updated)
Which of the following is FALSE for the SCHIP Balanced Budget Act? - answer
The SCHIP Balanced Budget Act is part of HIPAA.
Rationale: A transitional pass-through payment for innovative and generally
expensive medical devices, drugs, and biologicals is included in the OPPS, as
required by the Medicare, Medicaid, and SCHIP (State Children's Health
Insurance Program) Balanced Budget Refinement Act of 1999 (BBRA), also
known as the Balanced Budget Refinement Act (BBRA). HIPAA is not part of
BBRA.
What are pass-through payments? - answer Additional payments made for
certain drugs, biologicals, and medical devices.
Rationale: Pass-through payments are supplemental payments to cover the
incremental cost associated with certain medical devices, drugs, and
biologicals that are added to an existing service.
By what payment method is the inpatient hospital facility reimbursed by
Medicare? - answer IPPS/MS-DRG
, Rationale: The Medicare Inpatient Prospective Payment System (IPPS) was
developed to help Medicare predict and control costs for hospital inpatient
services. Medicare pays hospitals a fixed amount for inpatient services based
on the severity-adjusted diagnostic group, which is referred to as the Medicare
Severity Diagnosis Related Groups (MS-DRGs).
Which of the following is NOT a packaged service? - answer Anesthesia
professional services
Medicare assigns payment status indicator services to CPT ® and HCPCS Level
II codes provided where? - answer Outpatient hospitals and ASCs
Rationale: A payment status indicator is assigned to every HCPCS code to
identify how the service or procedure described by the code is paid under the
hospital OPPS. In Addendum B, for outpatient hospitals, the indicator is called
"status indicator." In the ASC Addenda, the indicator is called "payment
indicator."
What is the length of time a new category is eligible for pass-through payment?
- answer At least two years but not more than three years, beginning on the
date CMS establishes the category.
Rationale: Special drugs, such as chemotherapy drugs and devices or supplies
that are considered "new technology" items will need to be assigned new "pass-
through" codes to receive additional reimbursement. The HCPCS Level II C
codes are used under the OPPS to identify pass-through drugs and biologicals.
The additional payment for a given item is established for at least two, but not
more than three years.
For Medicare, how is each claim paid for outpatient facility reimbursement? -
answer Each claim is paid based on the determined interim outpatient
reimbursement rate.
EXAm(solved &
updated)
Which of the following is FALSE for the SCHIP Balanced Budget Act? - answer
The SCHIP Balanced Budget Act is part of HIPAA.
Rationale: A transitional pass-through payment for innovative and generally
expensive medical devices, drugs, and biologicals is included in the OPPS, as
required by the Medicare, Medicaid, and SCHIP (State Children's Health
Insurance Program) Balanced Budget Refinement Act of 1999 (BBRA), also
known as the Balanced Budget Refinement Act (BBRA). HIPAA is not part of
BBRA.
What are pass-through payments? - answer Additional payments made for
certain drugs, biologicals, and medical devices.
Rationale: Pass-through payments are supplemental payments to cover the
incremental cost associated with certain medical devices, drugs, and
biologicals that are added to an existing service.
By what payment method is the inpatient hospital facility reimbursed by
Medicare? - answer IPPS/MS-DRG
, Rationale: The Medicare Inpatient Prospective Payment System (IPPS) was
developed to help Medicare predict and control costs for hospital inpatient
services. Medicare pays hospitals a fixed amount for inpatient services based
on the severity-adjusted diagnostic group, which is referred to as the Medicare
Severity Diagnosis Related Groups (MS-DRGs).
Which of the following is NOT a packaged service? - answer Anesthesia
professional services
Medicare assigns payment status indicator services to CPT ® and HCPCS Level
II codes provided where? - answer Outpatient hospitals and ASCs
Rationale: A payment status indicator is assigned to every HCPCS code to
identify how the service or procedure described by the code is paid under the
hospital OPPS. In Addendum B, for outpatient hospitals, the indicator is called
"status indicator." In the ASC Addenda, the indicator is called "payment
indicator."
What is the length of time a new category is eligible for pass-through payment?
- answer At least two years but not more than three years, beginning on the
date CMS establishes the category.
Rationale: Special drugs, such as chemotherapy drugs and devices or supplies
that are considered "new technology" items will need to be assigned new "pass-
through" codes to receive additional reimbursement. The HCPCS Level II C
codes are used under the OPPS to identify pass-through drugs and biologicals.
The additional payment for a given item is established for at least two, but not
more than three years.
For Medicare, how is each claim paid for outpatient facility reimbursement? -
answer Each claim is paid based on the determined interim outpatient
reimbursement rate.
