HEIT 1250 - Bell Ringer Chapter 5

What was the goal of the Outpatient Prospective Payment System (OPPS) when it was implemented?

• to shift financial risk to hospitals

• to develop an Inpatient Only List

• to establish a reimbursement rate for ambulatory services

• to update the Common Procedure Coding System

Which of the following states that the median cost of the most expensive item or service cannot be more than double the median cost of the least expensive item within the same group?

• the two times rule

• the reasonable and necessary rule

• the logic rule

• the Medicare Part B rule

Which of the following is the standardized coding system used to identify procedures and submit claims to Medicare?

• HCPCS

• APC

• ASC

• OCE

Which of the following would be reimbursed under the HCPCS Level I code set?

• labratory work

• medications

• crutches

• ambulance services

When services with a status indicator are performed, what typically happens to the associated ancillary items used during that service?

• They are packaged into the payment.

• They are moved into the most expensive APC group.

• The American Medical Association recodes them.

• The two times rule will not be applied.

Why is it important to assign the correct APCs when a patient receives multiple services on the same day?

• APCs have varying reimbursement amounts

• to prevent classification as a single outpatient encounter.

• to increase the average weight of the APC

• to improve the conversion factor applied by CMS

What does it mean when a relative payment weight is higher than 1.000?

• More resources are needed to treat the patient.

• The payment for treatment decreases.

• More add-on payments will be included.

• Less resources are needed to treat the patient.

When is bundling most likely to occur when calculating payments under APCs?

• when predetermined services are performed together

• when minor ancillary services are associated with significant procedures

• when an outpatient prospective payment system is used

• when status indicators are not used to assign HCPCS codes

When would an ambulatory surgical center be used by a patient or care provider?

• when hospitalization is not required

• when insurance will not cover a treatment or procedure

• when short-term care and rehabilitation is needed

• when skilled care can be provided in a patient's home rather than a hospital

Under the Home Health Prospective Payment System (HHPPS), what is the basis for measuring patient outcomes in a quality improvement report?

• OASIS

• HHRG

• PDGM

• RUG