What is the name of the researcher who developed a system of classifying health services using resource based relative values & what hospital is the researcher associated with?
Dr. William Hsalo from Harvard
In the RBRVS, what is another term for the element that represents the cost of malpractice insurance?
PLI, Professional Liability Insurance
in the RBRVs, what is the term for across the board multiplier that transforms the geographical adjuted RVU into MPFS payment amount?
Conversion Factor
What does the term GPCI stand for?
Geographic Practice Cost Index
T or F Payments under the RBRVs are unaffected by the clinician type.
False
Define packaging and bundling as pertains to the OPPS.
Packaging is combining minor ancillary services associated with a significant procedure. Bundling is the combining of multiple significant procedures, or multiple units of the same significant procedure or an episode of care.
Name the 3 reimbursement methods used by OPPS.
APC (prospective payment) , fee schedule & cost based
T or F Procedures in OPPS with a status indicator of C are indicated as inpatient only; they must be provided to Medicare beneficiaries in an inpatient setting & are reimbursed under IPPS.
True
List 3 of the 9 APC types, providing the applicable payment status indicators.
V-clinical or emergency room visit, T-significant procedure, multiple reductions apply, S-significant procedure, not discounted when multiple.
Why did CMS established new technology APCs?
To ensure timely payment, which ensures that CMS get the best possible care.
T or F Medicare certified ASCs may share record keeping & financial and accounting systems with hospitals in the same parent corporation.
False
CMS created motivation for surgical procedures to migrate from the more expensive inpatient setting to the less expensive outpatient surgery setting without creating a motivation to shift procedures from the less expensive physician office setting to the more expensive outpatient surgery setting by creating a _____.
revision of the ASC list of covered procedures
How are multiple and bilateral procedures adjusted in the ASC PPS?
In multiples the first procedure i paid at 100%, with each of the other procedures being paid at 50%. Bilateral procedures are paid at 150%.
Which 3 modifiers are utilized for interrupted procedures in the ASC setting?
-73, -74, & -52
T or F Because ASC PPS uses the same APC groups as the OPPS, the payment rates for the ASC setting are the same as the hospital outpatient setting.
False
T or F Medicare payments made under the ESRD PPS can cover services rendered to children.
True
T or F In the ESRD PPS, a patient level adjustment for adults is high body mass index.
False
T or F The federal 304B drug pricing program makes prescription drugs available to eligible providers at a reduced price
True
T or F FQHAs, similar to RHCs, must be established in a non-urban areas.
False
T or F Medicare payments for a Medicare beneficiary's hospice services terminates at 6 months or the beneficiary's death, whichever comes first.
False
In the hospice PPS, which category of care has the lowest per diem rate of reimbursement?
