Revenue Chapter 8 CYU

  1. What tool does CMS require that SNFs use to collect & report clinical data about residents.
    Minimum Data Set (MDS)
  2. What tool does the SNF PPS use annually to adjust payment rates?
    Market basket
  3. What cost sharing applies to beneficiaries residing in an LTCH for 90 days?
    An inpatient deductable plus for days 61-90, a daily co-pay.
  4. T or F Even though MS-LTC-DRGs are based on the same general factors as the acute care MS-DRGs for the IPPS, MS-LTC-DRGs differ from the acute care MS-DRGs because MS-LTC-DRGs have relative weights and use quintiles for low volume.
  5. What converts the MS-LTC-DRG into an unadjusted payment amount?
    Federal base rate
  6. What is the tool used to collect the information about Medicare patients that drives payment in the IRF PPS?
    IRF PAI (Inpatient Rehabilitation Facility Patient Assessment Instrument)
  7. T or F IRF staff members record RICS on patient's PAI to classify their impairment categories.
    False They are not recorded on a patient's PAI
  8. What home health care services are consolidated into a single payment of HHAs?
    All physical, occupational & speech language therapies, skilled nursing care, home health aide services, medical social work services, all medical supplies including non-routine medical supplies ordered by the physician that are particular to the patient's condition. These are per 60 days episodes.
  9. When is LUPA used and how does it affect reimbursement?
    LUPA is used when HHA provides 4 or fewer visits in a 60 day episode. Instead of paying for an entire 60 day episode, each visit would be paid for separately with a special calculation for a 1 time initial visit.
  10. Name the 3 dimensions of case mix measured using elements from OASIS for HIPAA.
    Clinical severity (C), Functional status (F) & Service utilization (S)
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Revenue Chapter 8 CYU