How can physician payments be adjusted for the price differences among various parts of the country?
Each element of the RVU is multiplied by the Geographic Practice Cost Index (GPCI) which is based on market base for the area the physician is in.
What is the control mechanism the government uses on Medicare payments to physicians & how is it applied?
The conversion factor, once the 3 elements have been adjusted by the GPCI, they are added together & then multiplied by the conversion factor. The conversion factor is a fixed price based on inflation.
What are the bases for the 7 levels of service used in the ambulance services fee schedule?
The level of service is the skill set necessary to provide services & care; it is based on the National Emergency Medical Services Education and Practice Blueprint.
T or F When a patient is pronounced dead during the ambulance transport, Medicare payment rules are followed as if the patient was alive.
How is the"two-time rule" applied to APC groups?
Every procedure or services is assigned a median cost. The"two-time rule" states that a group of median cost procedures ir services, the most expensive procedure or service cannot cost more than"two-times" the cost of the least expensive procedure or service.
T or F CMS, not the APC Advisory Panel or MED-PAC, makes the final ruling for updates & changes to the OPPS.
T or F The number of APCs per encounter for a single patient is limited to 10.
False It's unlimited.
Describe how observation services are currently reimbursed under OPPS.
Observation now has a composite APC. The observation must meet the criteria for Level 1 or Level 2 to be paid for as a separate service. If the observation does not meet either criteria, then the observation is bundled with the visit or service encounter.
What adjustments, if any, are used under OPPS to account for cost differences among facilities under OPPS?
Wage index adjustment, permanent hold harmless add-on payment, rural sole community hospital add-on payment.
Describe how the ASC PPS conversion factor is different from the OPPS conversion factor.
Even though they are very similar, payment rates for ASCs are adjusted to reflect the lower cost of their settings.
Why are device intensive procedure APCs payments adjusted for ASCs?
In some cases, the cost of the device is greater than 50% of the cost of the entire procedure.
Which federal law mandated the current bundled payment system for ESRD?
Medicare Modernization Act (MMA) of 2003
What law consolidated the 4 federal primary care programs?
The Health Centers Consolidation Act of 1996
T or F Both FQHCs & RHCs must offer services using a sliding scale.
T or F In hospice PPS, palliative care provides relief of care givers.