Reimbursement Ch. 8
Covered skilled services of Home Health Agencies do not include: - answer doctors'
services
what reimbursement methodology is used in the LTCH PPS? - answercase rate
Under the SNF PPS what does consolidated billing mean? - answerSNFs must pay for
outpatient services that a resident may receive from outside vendors instead of the
vendors submitting their bills to CMS
In most situations, for a facility to be defined as an LTCH, the lengths of stay of its
Medicare patients must be at least how long? - answer25 days
What converts the MS-LTC-DRG relative weight into a payment? - answerstandard
federal rate
What cost-sharing applies to a Medicare beneficiary who did NOT have an immediately
preceding admission at an acute care hospital AND resides in an LTCH for 90 days? -
answer-Inpatient deductible for the 90-day benefit period
-Daily coinsurance payment for days 61 through 90
Under Medicare's prospective payment system for long-term care hospitals, all of the
following elements are used to group patients into a MS-LTC-DRG EXCEPT: -
answerQualifying diagnosis at acute inpatient hospital prior to admission to LTCH
In Medicare's prospective payment system for long-term care hospitals, what
classification is used to adjust for case mix? - answerMS-LTC-DRGs
Which of the following is NOT one of the components of the payment rate for a RUG? -
answerphysician component
Patients with all the following conditions are appropriate candidates of LTCHs EXCEPT:
- answeracute myocardial infarction
In Medicare's prospective payment system for skilled nursing facilities, which data set
determines a resident's classification into a resource utilization group? - answerMDS
T/F: In an LTCH facility, coders should code the diagnosis that the patient was treated
for in the acute care hospital. - answerfalse
How many RUGs are there? - answer66
, What tool does CMS require that skilled nursing facilities use to collect and to report
clinical data on residents? - answerminimum data set
A patient with which condition is an appropriate candidate for an LTCH? -
answerventilator dependent emphysema
Which of the following does NOT impact the RUG used in the SNF PPS? -
answercomorbid conditions
To be eligible for SNF, Medicare beneficiaries have to have: - answera 3 day acute care
inpatient hospitalization
Which of the following is NOT a case-level adjustment for a MS-LTC-DRG - answerlong
term stay outlier
T/F: Even though Medicare-severity long-term care diagnosis related groups (MS-LTC-
DRGs) are based on the same general factors as the acute-care MS-DRGs for the
IPPS, MS-LTC-DRGs differ from acute-care MS-DRGs because MS-LTC-DRGs have
different relative weights and use quintiles for low volumes. - answertrue
In Medicare's prospective payment system for skilled nursing facilities, what
classification is used to adjust for case mix? - answerRUGs
CMS' analyst divide admissions to skilled nursing facilities into upper and lower
categories. To which of the following categories does the "presumption of coverage"
apply? - answerUpper 52 RUGs
What tool does the SNF PPS use to annually adjust the base rate for differences in local
markets? - answermarket basket
In terms of grouping and reimbursement, how are MS-LTC-DRGs and acute care MS-
DRGs similar? - answerbased on principal diagnosis
What tool does CMS require that long-term care hospitals use to collect and to report
clinical data on patients? - answerLong-term care hospital Continuity Assessment and
Record Evaluation (CARE) data set
The most commonly used of the post acute care systems is the: - answerskilled nursing
facility
Which reimbursement methodology is used for the SNF PPS? - answerper diem
What tool, that drives payment, is used to collect information about Medicare patients in
the IRF PPS? - answerIRF PAI
Covered skilled services of Home Health Agencies do not include: - answer doctors'
services
what reimbursement methodology is used in the LTCH PPS? - answercase rate
Under the SNF PPS what does consolidated billing mean? - answerSNFs must pay for
outpatient services that a resident may receive from outside vendors instead of the
vendors submitting their bills to CMS
In most situations, for a facility to be defined as an LTCH, the lengths of stay of its
Medicare patients must be at least how long? - answer25 days
What converts the MS-LTC-DRG relative weight into a payment? - answerstandard
federal rate
What cost-sharing applies to a Medicare beneficiary who did NOT have an immediately
preceding admission at an acute care hospital AND resides in an LTCH for 90 days? -
answer-Inpatient deductible for the 90-day benefit period
-Daily coinsurance payment for days 61 through 90
Under Medicare's prospective payment system for long-term care hospitals, all of the
following elements are used to group patients into a MS-LTC-DRG EXCEPT: -
answerQualifying diagnosis at acute inpatient hospital prior to admission to LTCH
In Medicare's prospective payment system for long-term care hospitals, what
classification is used to adjust for case mix? - answerMS-LTC-DRGs
Which of the following is NOT one of the components of the payment rate for a RUG? -
answerphysician component
Patients with all the following conditions are appropriate candidates of LTCHs EXCEPT:
- answeracute myocardial infarction
In Medicare's prospective payment system for skilled nursing facilities, which data set
determines a resident's classification into a resource utilization group? - answerMDS
T/F: In an LTCH facility, coders should code the diagnosis that the patient was treated
for in the acute care hospital. - answerfalse
How many RUGs are there? - answer66
, What tool does CMS require that skilled nursing facilities use to collect and to report
clinical data on residents? - answerminimum data set
A patient with which condition is an appropriate candidate for an LTCH? -
answerventilator dependent emphysema
Which of the following does NOT impact the RUG used in the SNF PPS? -
answercomorbid conditions
To be eligible for SNF, Medicare beneficiaries have to have: - answera 3 day acute care
inpatient hospitalization
Which of the following is NOT a case-level adjustment for a MS-LTC-DRG - answerlong
term stay outlier
T/F: Even though Medicare-severity long-term care diagnosis related groups (MS-LTC-
DRGs) are based on the same general factors as the acute-care MS-DRGs for the
IPPS, MS-LTC-DRGs differ from acute-care MS-DRGs because MS-LTC-DRGs have
different relative weights and use quintiles for low volumes. - answertrue
In Medicare's prospective payment system for skilled nursing facilities, what
classification is used to adjust for case mix? - answerRUGs
CMS' analyst divide admissions to skilled nursing facilities into upper and lower
categories. To which of the following categories does the "presumption of coverage"
apply? - answerUpper 52 RUGs
What tool does the SNF PPS use to annually adjust the base rate for differences in local
markets? - answermarket basket
In terms of grouping and reimbursement, how are MS-LTC-DRGs and acute care MS-
DRGs similar? - answerbased on principal diagnosis
What tool does CMS require that long-term care hospitals use to collect and to report
clinical data on patients? - answerLong-term care hospital Continuity Assessment and
Record Evaluation (CARE) data set
The most commonly used of the post acute care systems is the: - answerskilled nursing
facility
Which reimbursement methodology is used for the SNF PPS? - answerper diem
What tool, that drives payment, is used to collect information about Medicare patients in
the IRF PPS? - answerIRF PAI
