1.All of the following are facility level adjustments EXCEPT: Teaching Hospital

Question

1.All of the following are facility level adjustments EXCEPT:

Teaching Hospital

Full service emergency department

Wage index

Ms-drg

2.HeartCenter hospital is submitting a request for payment for a patient with Chronic Obstructive Pulmonary Disease with an MCC. The MS-DRG for the patient is 190, which has a relative weight of 1.2076. The hospital’s base rate (including all applicable adjustments) is $1000. What will the hospital’s reimbursement from Medicare be for the patient’s stay?

$1,000.00

$190,000.00

$1,207.60

3.Which of the following providers receives reimbursement from Medicare for services that is NOT adjusted for the severity of the individual patient?

Physician

Inpatient medical (acute care) hospital

Inpatient psychiatric hospital

Skilled nursing facility

4.Medicare reimbursements for which type of healthcare provider are made for 60 day treatment periods?

Inpatient psychiatric hospitals

Skilled nursing facilities

Ambulatory surgery centers

Home health agencies

5.Which provider type may receive a separate reimbursement for each service delivered to a patient?

Inpatient rehabilitation facility

Physicians

Inpatient acute care facility

Home health agency

6.Home Health Agency reimbursements are adjusted to reflect a patient’s needs based on?

RUGs

HHRG

DRG

CPT codes

7.)Inpatient psychiatric facilities are paid more for the first few days of a stay than the later days.

True

False

Explanation / Answer

1 d Payments are adjusted at the facility level to account for geographic variationssuch as wage differences ,cost of living and rural location.

2 c Formula for calculating a facility paytment is MS-DRG Relative weight *facility base rate=dollar reimbursement

ie 1.2076*1000=1207.6

3 a

4d The Home health payment system will provide Home health agencies with payments for each 60 day episode of care for each beneficiary.

5b Under Fee for services reimbursement a physicians revenue is based solely on what procedures they perform and they do increase their revenue by increasing the number of services they perform.

6b HHRG ie Home Health Related Groupadjusts payment for a beneficiery condition and needs.

7 True.It was determined that the per diem cost for psychiatric cases decreases as the length of the stay progress.

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