Chapter 17 Review Health Insurance
A patient's DRG categorization depends on the coding and classification of the patient's
admitting diagnosis only. - answer false
Which of the following is not one of the three components that make up the total relative
value unit (RVU)? - answer Patient diagnosis
A type of reimbursement used by CMS that bases Medicare payments on a
predetermined, fixed amount (e.g., DRGs for inpatient hospital services) is called -
answer prospective payment system.
When determining the applicable DRG classification, the key piece of information is the
patient's - answer principal diagnosis
The Prospective Payment System (PPS) is Medicare's system for reimbursing which of
the following? - answer Part A inpatient hospital costs
The basic idea of resource utilization groups (RUGs) is to calculate payments to -
answer skilled nursing facilities.
An agreement between the provider and a third-party payer whereby the provider
agrees to accept the payer's allowed fee as payment in full for a particular service or
procedure is referred to as - answera contractual write-off
Bad debt write-offs are the same as contractual write-offs. - answerfalse
A method of payment for healthcare services whereby the provider is paid a fixed
amount for each patient regardless of the actual number or nature of services provided
is called - answercapitation
Most patient accounting systems available today are capable of performing the same
basic system functions. - answertrue
The federal payment rate adjustment for LTCH stays that are significantly shorter than
the average length of stay for a long-term care DRG is referred to as - answera short-
stay outlier
To qualify for IRF PPS rates, an inpatient hospital must establish that 100% of its
patients meet certain criteria for intensive inpatient rehabilitation. - answerfalse
Congress establishes all Medicare and Medicaid payment rules. - answerfalse
A patient's DRG categorization depends on the coding and classification of the patient's
admitting diagnosis only. - answer false
Which of the following is not one of the three components that make up the total relative
value unit (RVU)? - answer Patient diagnosis
A type of reimbursement used by CMS that bases Medicare payments on a
predetermined, fixed amount (e.g., DRGs for inpatient hospital services) is called -
answer prospective payment system.
When determining the applicable DRG classification, the key piece of information is the
patient's - answer principal diagnosis
The Prospective Payment System (PPS) is Medicare's system for reimbursing which of
the following? - answer Part A inpatient hospital costs
The basic idea of resource utilization groups (RUGs) is to calculate payments to -
answer skilled nursing facilities.
An agreement between the provider and a third-party payer whereby the provider
agrees to accept the payer's allowed fee as payment in full for a particular service or
procedure is referred to as - answera contractual write-off
Bad debt write-offs are the same as contractual write-offs. - answerfalse
A method of payment for healthcare services whereby the provider is paid a fixed
amount for each patient regardless of the actual number or nature of services provided
is called - answercapitation
Most patient accounting systems available today are capable of performing the same
basic system functions. - answertrue
The federal payment rate adjustment for LTCH stays that are significantly shorter than
the average length of stay for a long-term care DRG is referred to as - answera short-
stay outlier
To qualify for IRF PPS rates, an inpatient hospital must establish that 100% of its
patients meet certain criteria for intensive inpatient rehabilitation. - answerfalse
Congress establishes all Medicare and Medicaid payment rules. - answerfalse
