Healthcare Reimbursement Ch. 8 Test
Questions and Correct Answers
Activities of daily living (ADL) ✅Everyday tasks that people can perform without
assistance and that are used to measure their functional status and, thus, their need for
institutional or assisted care.
Average length of stay (ALOS) ✅Average number of days patients are hospitalized.
Base rate ✅1. Rate per discharge for operating and capital-related components for an
acute-care hospital. 2. Prospectively set payment rate made for services that Medicare
beneficiaries receive in healthcare settings.
Base year ✅1. Most recent 12-month period for which the Centers for Medicare and
Medicaid Services has compete and available data on which to calculate and calibrate
rates and weights. 2. Can't at reporting period in which a rate is based.
Budget neutrality factor ✅Percentage in the Inpatient Rehabilitation Facility
Prospective Payment System that alters payment to maintain budget neutrality.
Case-mix diagnosis ✅Diagnoses in the home health prospective payment system that
feed into the home health case-mix grouper.
Case-mix group ✅Class of functionally similar discharges in the inpatient rehabilitation
facility prospective payment system. Bases of similarity is impairment, functional
capability, age and comorbidities.
Certification ✅1. Approval based on inspection by state health agencies, hospitals,
nursing homes, and dialysis facilities. 2. Process in which a physician verifies and
documents that the health services that a patient receives are medically necessary.
Cognitive ✅Related to mental abilities, such as talking, memory, and problem solving.
Compliance percentage ✅Minimum percentage of inpatient patients receiving
intensive rehabilitation services for 13 qualifying conditions to be classified as an
inpatient rehabilitation facility.
Concurrent therapy ✅The practice of one professional therapist treating multiple
patients at the same time while the patients are performing different therapeutic
activities in which residents cannot benefit from observing other residents in the group
because everyone is performing different activities.
, Confined to the home ✅Normal inability to leave the home in which leaving the home
requires considerable and taxing effort, requires physical assistance, or is medically
contraindicated.
Consolidated billing ✅Facility submits one consolidated billed to Medicare
administrative contractor covering the services, such as laboratory, x-rays, and
pharmacy, received by the patient, client, or resident during admission to the facility,
including services from outside vendors.
Core-based statistical area (CBSA) ✅Statistical geographic entity consisting of the
county or county is associated with at least one core of at least 10,000 people, plus
adjacent counties have any high degree of social and economic integration with the
core as measured through commuting ties with the counties containing the core.
Cost report ✅Report required from providers on an annual basis for the Medicare
program to make a proper determination of amounts payable to providers under its
provisions.
Durable medical equipment (DME) ✅Equipment and supplies, such as oxygen
equipment, wheelchairs, crutches, or blood testing strips for diabetics, ordered by a
healthcare provider for every day or extended use.
Episode of care ✅One or more healthcare services given by a provider during a
specific period of relatively continuous care in relation to a particular health or medical
problem or situation.
Etiologic diagnosis ✅Underlying cause of the problem that led to the condition
requiring admission to an inpatient rehabilitation facility.
Functional independence assessment tool ✅Standardized tool to measure the severity
of patients' impairments and rehabilitation settings. The tool captures characteristics
that reflect the functional status of patients.
Functional status ✅Patient's ability to perform the activities of daily living.
Group therapy ✅The practice of one therapist providing the same therapeutic services
to everyone in the group, in which residents may benefit by observing other residents in
the group performing the same activity.
Health Insurance Prospective Payment System (HIPPS) codes ✅Five-character
alphanumeric code used in the home health prospective payment system and in the
inpatient rehabilitation facility prospective payment system.
High-cost outlier ✅Case with extraordinarily high costs exceeding in the typical cost of
similar cases.
Questions and Correct Answers
Activities of daily living (ADL) ✅Everyday tasks that people can perform without
assistance and that are used to measure their functional status and, thus, their need for
institutional or assisted care.
Average length of stay (ALOS) ✅Average number of days patients are hospitalized.
Base rate ✅1. Rate per discharge for operating and capital-related components for an
acute-care hospital. 2. Prospectively set payment rate made for services that Medicare
beneficiaries receive in healthcare settings.
Base year ✅1. Most recent 12-month period for which the Centers for Medicare and
Medicaid Services has compete and available data on which to calculate and calibrate
rates and weights. 2. Can't at reporting period in which a rate is based.
Budget neutrality factor ✅Percentage in the Inpatient Rehabilitation Facility
Prospective Payment System that alters payment to maintain budget neutrality.
Case-mix diagnosis ✅Diagnoses in the home health prospective payment system that
feed into the home health case-mix grouper.
Case-mix group ✅Class of functionally similar discharges in the inpatient rehabilitation
facility prospective payment system. Bases of similarity is impairment, functional
capability, age and comorbidities.
Certification ✅1. Approval based on inspection by state health agencies, hospitals,
nursing homes, and dialysis facilities. 2. Process in which a physician verifies and
documents that the health services that a patient receives are medically necessary.
Cognitive ✅Related to mental abilities, such as talking, memory, and problem solving.
Compliance percentage ✅Minimum percentage of inpatient patients receiving
intensive rehabilitation services for 13 qualifying conditions to be classified as an
inpatient rehabilitation facility.
Concurrent therapy ✅The practice of one professional therapist treating multiple
patients at the same time while the patients are performing different therapeutic
activities in which residents cannot benefit from observing other residents in the group
because everyone is performing different activities.
, Confined to the home ✅Normal inability to leave the home in which leaving the home
requires considerable and taxing effort, requires physical assistance, or is medically
contraindicated.
Consolidated billing ✅Facility submits one consolidated billed to Medicare
administrative contractor covering the services, such as laboratory, x-rays, and
pharmacy, received by the patient, client, or resident during admission to the facility,
including services from outside vendors.
Core-based statistical area (CBSA) ✅Statistical geographic entity consisting of the
county or county is associated with at least one core of at least 10,000 people, plus
adjacent counties have any high degree of social and economic integration with the
core as measured through commuting ties with the counties containing the core.
Cost report ✅Report required from providers on an annual basis for the Medicare
program to make a proper determination of amounts payable to providers under its
provisions.
Durable medical equipment (DME) ✅Equipment and supplies, such as oxygen
equipment, wheelchairs, crutches, or blood testing strips for diabetics, ordered by a
healthcare provider for every day or extended use.
Episode of care ✅One or more healthcare services given by a provider during a
specific period of relatively continuous care in relation to a particular health or medical
problem or situation.
Etiologic diagnosis ✅Underlying cause of the problem that led to the condition
requiring admission to an inpatient rehabilitation facility.
Functional independence assessment tool ✅Standardized tool to measure the severity
of patients' impairments and rehabilitation settings. The tool captures characteristics
that reflect the functional status of patients.
Functional status ✅Patient's ability to perform the activities of daily living.
Group therapy ✅The practice of one therapist providing the same therapeutic services
to everyone in the group, in which residents may benefit by observing other residents in
the group performing the same activity.
Health Insurance Prospective Payment System (HIPPS) codes ✅Five-character
alphanumeric code used in the home health prospective payment system and in the
inpatient rehabilitation facility prospective payment system.
High-cost outlier ✅Case with extraordinarily high costs exceeding in the typical cost of
similar cases.
