Chapter 6 Review
Resource Utilization Groups (RUGs). - answer The case-mix management system that
utilizes information from the minimum data set (MDS) in long-term care settings is called
OASIS - answer The prospective payment system used to reimburse home health
agencies for patients with Medicare utilizes data from
medical visits - answer All of the following items are "packaged" under the Medicare
outpatient prospective payment system, EXCEPT for
physician work, practice expense, and malpractice insurance expense. - answer Under
the RBRVS, each HCPCS/CPT code contains three components, each having assigned
relative value units. These three components are
APCs. - answer The prospective payment system used to reimburse hospitals for
Medicare hospital outpatients is called
financially liable for charges in excess of the Medicare fee schedule, up to a limit. -
answerA patient was seen by Dr. Zachary. The charge for the office visit was $125. The
Medicare beneficiary had already met his deductible. The Medicare fee schedule
amount is $100. Dr. Zachary does not accept assignment. The office manager will apply
a practice termed as "balance billing," which means that the patient is
skilled nursing facilities - answerThe prospective payment system based on resource
utilization groups (RUGs) is used for reimbursement to ____________________ for
patients with Medicare.
remittance advice - answerThe _______________ is a statement sent to the provider to
explain payments made by third-party payers.
only one amount (group) of reimbursement per hospitalization. - answerThe MS-DRG
(Medicare Severity-Diagnosis-Related Group) system was designed to pay
UB-04. - answerThe standard paper claim form used by hospitals (before electronic
format was standard) to request reimbursement for inpatient services provided is called
the
Medicare summary notice - answerThe ________________________ refers to a
statement sent to the patient to show how much the provider billed, how much Medicare
reimbursed the provider, and what the patient must pay the provider.
Resource Utilization Groups (RUGs). - answer The case-mix management system that
utilizes information from the minimum data set (MDS) in long-term care settings is called
OASIS - answer The prospective payment system used to reimburse home health
agencies for patients with Medicare utilizes data from
medical visits - answer All of the following items are "packaged" under the Medicare
outpatient prospective payment system, EXCEPT for
physician work, practice expense, and malpractice insurance expense. - answer Under
the RBRVS, each HCPCS/CPT code contains three components, each having assigned
relative value units. These three components are
APCs. - answer The prospective payment system used to reimburse hospitals for
Medicare hospital outpatients is called
financially liable for charges in excess of the Medicare fee schedule, up to a limit. -
answerA patient was seen by Dr. Zachary. The charge for the office visit was $125. The
Medicare beneficiary had already met his deductible. The Medicare fee schedule
amount is $100. Dr. Zachary does not accept assignment. The office manager will apply
a practice termed as "balance billing," which means that the patient is
skilled nursing facilities - answerThe prospective payment system based on resource
utilization groups (RUGs) is used for reimbursement to ____________________ for
patients with Medicare.
remittance advice - answerThe _______________ is a statement sent to the provider to
explain payments made by third-party payers.
only one amount (group) of reimbursement per hospitalization. - answerThe MS-DRG
(Medicare Severity-Diagnosis-Related Group) system was designed to pay
UB-04. - answerThe standard paper claim form used by hospitals (before electronic
format was standard) to request reimbursement for inpatient services provided is called
the
Medicare summary notice - answerThe ________________________ refers to a
statement sent to the patient to show how much the provider billed, how much Medicare
reimbursed the provider, and what the patient must pay the provider.
