What tool does CMS require that skilled nursing facilities use to collect and to report clinical data on residents?
Medicare and Medicaid Payment Systems The MDS
is used as a data collection tool to classify Medicare and Medicaid residents into the Resource Utilization Groups (RUG-III).
What tool does CMS require that long term care hospitals used to collect and report clinical data on patients?
Standardized data are to be collected by the commonly used assessment instruments: The
Long-Term Care Hospital CARE Data Set (LCDS) for LTCHs
, the Minimum Data Set (MDS) for SNFs, the Outcome and Assessment Information Set (OASIS) for HHAs, and the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF …
What tool does CMS require that home health agencies use to collect?
The instrument/data collection tool used to collect and report assessment data by home health agencies is called
the Outcome and Assessment Information Set (OASIS)
.
What tool which drives payment is used to collect information about Medicare patients in the inpatient rehabilitation facility PPS?
The PC Pricer
is a tool used to estimate Medicare PPS payments.
Which software do facilities use to transmit IRF PAIs to the Centers for Medicare and Medicaid Services quizlet?
Facilities transmit IRF PAIs to the Centers for Medicare and Medicaid Services using
CMS’ free IRVEN software
.
What are the two major categories of pay for performance models?
There are two basic types of Pay for Performance designs being deployed for hospitals. With the first, payers lower global FFS payments and use the funds to reward hospitals based on how well they perform across process, quality, and efficiency measures.
How are MS LTC DRGs determined?
How are MS-LTC-DRGs determined? MS-LTC-DRGs are
determined by the principal diagnosis, up to eight additional diagnoses, up to six procedures, sex, and discharge status
. For inpatient rehabilitation facility patients, codes on the IRF PAI should follow the UHDDS and the UB-04 guidelines.
Which of the following is the most common type of healthcare services reimbursement?
The most common type of prospective reimbursement is
a service benefit plan
which is used primarily by managed care organizations. Most insurance policies require a contribution from the covered individual which may be a copayment, deductible or coinsurance which is called cost participation.
How do I submit oasis to CMS?
To Submit an OASIS file
select the OASIS Submissions link and follow the upload instructions
. It is important to note that OASIS files must now be in a zip format. The default menu item displayed is File Upload. To upload select Browse and select the file from the folder it was saved to on the computer.
What is PDGM in home health care?
CMS finalized a new case-mix classification model, the
Patient-Driven Groupings Model
(PDGM), effective January 1, 2020. The PDGM relies more heavily on clinical characteristics, and other patient information to place home health periods of care into meaningful payment categories.
Which of the following is the prospective reimbursement method used to pay for the care provided by skilled nursing facilities?
The Medicare Patient-Driven Payment Model (PDPM)
is a major overhaul to the current skilled nursing facility (SNF) prospective payment system (PPS). It is designed to address concerns that a payment system based on the volume of services provided creates inappropriate financial incentives.
What is the maximum number of APCs that may be assigned per encounter?
| Question Answer | What is the maximum number of APCs that may be assigned per encounter? Unlimited | Under the HOPPS, outpatient services that are similar both clinically and in use of resources are assigned to separate groups called ___. Ambulatory Payment Classifications |
|---|
| Question Answer | What is the general term for software that assigns inpatient diagnosis related groups? Grouper | What is Medicare’s term for a facility with a high percentage of low income patients? Disproportionate share hospital |
|---|
Which of the following services is most likely to be considered medically necessary?
| Question Answer | Which of the following services is most likely to be considered medically necessary? Standard of care for health condition | All of the following sets represent criteria for medical necessity and utilization review except: Federal register index and ratings |
|---|
What services are excluded from SNF consolidated billing?
- Physician’s professional services;
- Certain dialysis-related services, including covered ambulance transportation to obtain the dialysis services;
What is the term for an MCO that serves Medicare beneficiaries quizlet?
The patients out-of-pocket cost will be increased. Which types of MCO allows patients to choose how they will receive services at the time that the patients need the service? POS. What is the term for an MCO that serves Medicare beneficiaries?
Medicare Advantage
.
