IPPS ✅Questions & Answers
- Rising healthcare payments using the funds in the Medicare Trust at a rate faster than
US workers were contributing dollars
- Fraud and abuse in the system, wasting funding
- Payment rules not uniformly applied across the nation. - ANSWERSReform in the
federal method of reimbursing providers for healthcare services resulted from three
trends:
Inpatient Prospective Payment System (IPPS) - ANSWERSThe ______ system was the
first provider type to go under a PPS by the government.
October 1, 1983 - ANSWERSWhen was the IPPS system first adopted?
Facility; Provider - ANSWERSIPPS explains how a _______ is paid, rather than how a
________ is paid.
September 1-October 30 - ANSWERSWhat is the rate year for IPPS?
False (This should be IPPS) - ANSWERST or F: The success of IPF PPS prompted
Congress to authorize the DHHS to develop and implement PPSs across the continuum
of care.
Inpatient Prospective Payment System (IPPS) - ANSWERSThe Medicare
reimbursement system for inpatient services provided in an acute-care setting.
- Psychiatric Units
- Long-Term Care Units
- Rehabilitation Units
(Each of these is reimbursed under a different prospective care system) -
ANSWERSWhich types of settings are excluded from the IPPS payment method?
Case-Rate Methodology - ANSWERSWhat type of reimbursement methodology does
IPPS use?
Acute Care - ANSWERSThe federal government movement from retrospective to
prospective payment started with the _______ payment system.
True - ANSWERST or F: Under the new PPS payment system, hospitals constantly
checked patients to see if they were well enough to be able to be sent home.
Charge * CCR - ANSWERSHow is cost calculated under the IPPS payment system?
Cost Report - ANSWERSWhere do hospitals report their costs and facility charges?
, To base reimbursement on what it REALLY costs to treat a patient. - ANSWERSWhy
does CMS use cost-to-charge ratios?
- Medicare payments to hospitals grew on average by 19% annually.
- The Medicare hospital deductible expanded, creating a burden for Medicare
beneficiaries.
- The solvency of the Medicare Trust Fund was endangered because of the increase of
healthcare costs.
- The increase in Medicare expenditures for hospital inpatient care jeopardized the
ability of Medicare to fund other needed health programs.
- Under the variable cost-based payment system, Medicare paid up to sixfold
differences across hospitals for comparable services.
- The reporting requirements of the cost-based system were some of the most
burdensome for the federal government. - ANSWERSWhat impact did steep increases
in healthcare costs have on the Medicare Program?
- Payment rates are to be established in advance and fixed for the fiscal period to which
they apply.
- Payment rates are not automatically determined by the hospital's past or current actual
cost.
- Prospective payment rates are payment in full.
- The hospital retains the profit or suffers a loss resulting from the difference between
the payment rate and the hospital's cost, creating an incentive for cost control. -
ANSWERSWhat are the four guiding principles of prospective payment?
Tax Equity and Fiscal Responsibility Act (TEFRA) - ANSWERSCalled for the
implementation of a PPS for hospital inpatients on October 1, 1983.
Diagnosis-Related Group Classification - ANSWERS- This organizes inpatient
admissions into larger groups for reimbursement purposes.
-- Essentially, payment is based on the final diagnosis.
When the patient is formally admitted into the hospital with a physician's order; When
the physician discharges the patient. - ANSWERSWhen does an inpatient admission
start? When does it end?
Diagnosis-Related Group (DRG) System - ANSWERSThis system takes into
consideration the role that a hospital's composition of patients plays in influencing costs.
Resource Intensity - ANSWERSMeasures the amount of resources required to treat a
patient.
Relative Weight - ANSWERS- This is how relative intensity is represented.
-- Each DRG is assigned this and it is intended to represent the resource intensity of the
clinical group.
- Rising healthcare payments using the funds in the Medicare Trust at a rate faster than
US workers were contributing dollars
- Fraud and abuse in the system, wasting funding
- Payment rules not uniformly applied across the nation. - ANSWERSReform in the
federal method of reimbursing providers for healthcare services resulted from three
trends:
Inpatient Prospective Payment System (IPPS) - ANSWERSThe ______ system was the
first provider type to go under a PPS by the government.
October 1, 1983 - ANSWERSWhen was the IPPS system first adopted?
Facility; Provider - ANSWERSIPPS explains how a _______ is paid, rather than how a
________ is paid.
September 1-October 30 - ANSWERSWhat is the rate year for IPPS?
False (This should be IPPS) - ANSWERST or F: The success of IPF PPS prompted
Congress to authorize the DHHS to develop and implement PPSs across the continuum
of care.
Inpatient Prospective Payment System (IPPS) - ANSWERSThe Medicare
reimbursement system for inpatient services provided in an acute-care setting.
- Psychiatric Units
- Long-Term Care Units
- Rehabilitation Units
(Each of these is reimbursed under a different prospective care system) -
ANSWERSWhich types of settings are excluded from the IPPS payment method?
Case-Rate Methodology - ANSWERSWhat type of reimbursement methodology does
IPPS use?
Acute Care - ANSWERSThe federal government movement from retrospective to
prospective payment started with the _______ payment system.
True - ANSWERST or F: Under the new PPS payment system, hospitals constantly
checked patients to see if they were well enough to be able to be sent home.
Charge * CCR - ANSWERSHow is cost calculated under the IPPS payment system?
Cost Report - ANSWERSWhere do hospitals report their costs and facility charges?
, To base reimbursement on what it REALLY costs to treat a patient. - ANSWERSWhy
does CMS use cost-to-charge ratios?
- Medicare payments to hospitals grew on average by 19% annually.
- The Medicare hospital deductible expanded, creating a burden for Medicare
beneficiaries.
- The solvency of the Medicare Trust Fund was endangered because of the increase of
healthcare costs.
- The increase in Medicare expenditures for hospital inpatient care jeopardized the
ability of Medicare to fund other needed health programs.
- Under the variable cost-based payment system, Medicare paid up to sixfold
differences across hospitals for comparable services.
- The reporting requirements of the cost-based system were some of the most
burdensome for the federal government. - ANSWERSWhat impact did steep increases
in healthcare costs have on the Medicare Program?
- Payment rates are to be established in advance and fixed for the fiscal period to which
they apply.
- Payment rates are not automatically determined by the hospital's past or current actual
cost.
- Prospective payment rates are payment in full.
- The hospital retains the profit or suffers a loss resulting from the difference between
the payment rate and the hospital's cost, creating an incentive for cost control. -
ANSWERSWhat are the four guiding principles of prospective payment?
Tax Equity and Fiscal Responsibility Act (TEFRA) - ANSWERSCalled for the
implementation of a PPS for hospital inpatients on October 1, 1983.
Diagnosis-Related Group Classification - ANSWERS- This organizes inpatient
admissions into larger groups for reimbursement purposes.
-- Essentially, payment is based on the final diagnosis.
When the patient is formally admitted into the hospital with a physician's order; When
the physician discharges the patient. - ANSWERSWhen does an inpatient admission
start? When does it end?
Diagnosis-Related Group (DRG) System - ANSWERSThis system takes into
consideration the role that a hospital's composition of patients plays in influencing costs.
Resource Intensity - ANSWERSMeasures the amount of resources required to treat a
patient.
Relative Weight - ANSWERS- This is how relative intensity is represented.
-- Each DRG is assigned this and it is intended to represent the resource intensity of the
clinical group.
