chapter 9 cms reimbursment methodologies Flashcards
ALL PATAIENT DIAGNOSIS RELATED GROUP
DRG SYSTEM ADAPTED FOR USE BY THIRD PARTY PAYERS TO REIBURSE HOSPITALS FOR INPATIENT CARE PROVIDED TO NON MEDICARE BENFICIARIES
ALL PATIENT REFINED DOAGNOSIS RELATED GROUP
SYSTEM THAT CLASSIFIES PATIENTS ACCORDING TO REASON FOR ADMISSION SEVERITY OF ILLNESS AND RISK OF MORTALITY
AMBULABCE FEE SCHEDULE
PAYMENT SYSTEM FOR AMBULANCE SERVICES PROVIDED TO MEDICARE BENEFICIARIES
AMBULATORY SURGICAL CENTER
STATE LICENSED MEDICARE CERIFIED SUPPLIER OF SURGICAL HEALTH CARE SERVICES THAT MUST ACCEPT ASSIGMENT ON MEDICARE CLAIMS
AMBULATORY SURGICAL CENTER PAYMENT RATE
PEDETERMINED AMOUNT FOR WHICH ASC SERVICES ARE REIMBURSED AT 80 PERCENT FOR RREGIONAL WAGE VARIATIONS
AMBULATORY SURGICAL CENTER QUALITY REPORTING PROGRAM
PAY FOR REPORTING PROGRAM THA TREQUIRED AMBULATORY SURGICLA CENTERS TO MEET ADMINISTRATIVR DATA COLLECTIONS REPORTING AND OTHER PROGRAMS REQUIREMENTS OR RECEIVE A REDUCTION OF 2.0 PERCENT POINTS IN THEIR ANNUAL PAYMENT UPDATE FOR FAILURE TO MEET THERSE PROGRAM REQUIREMENTS.
BALANCED BILLING
BILLING BENEFICIARIES FOR AMOUNTS NOT REIMBURSED BY PAYERS THIS PRACTICE IS PROHIBITED Y MEDICARE REGULATIONS
BUNDLED PAYMENT
PREDETERMINED PAYMANENT AMOUNT FOR ALL SERVICES PROVIDED DURING AN EPISODE OF CARE
CASE MIX
THE TYPES AND CATEGORIES OF PATIENTS TREATED BUY HEALTH CARE FACILITY OR PROVIDER
CASE MIX INDEX
RELATIVE WEITGHT ASSIGNED FOR AS FACILITYS PATIENT POPULATION IT IS USED IN A FORMULA TO CALCUATE HEALTH CARE REIMBURSEMENT
CASE MIX MANAGEMENT
ALLOWS HEALTH CARE FACILITIES AND PROVIDERS TO DETERMINE ANTICIPATED HEALTH CARE NEED S BY REVIEWING DATA ANALYTICS ABOUT TYPES ANDN OR CATOEGORIES OF PATIENT TREATED
CASE RATE
PREDETERMINED PAYEMNT FOR AN ENCOUNTER REGARDLESS OF THE NUMBER OF SERVICES PROVIDED OR LENGHT OF ENCOUNTER
CLINICAL LABORATORY FEE SCHEDULE
CLINICAL DOCUMENTATION IMPROVEMENT
CONCERSION FACTOR
DOLLOR MULTIPLIER THAT CONVERTS RELATIVE VALUE UNITS INTO PAYMENTS
DIAGNOSTIC AND STATISTICAL MANUAL
CLASSIFIES MENTAL HEALTH DISORDERS AND IS BASED ON ICD PUBLISHED BY THE AMERICAN PSYCHIATRIC ASSOCIATION
DISPROPORTIONATE SHARE HOSPITAL ADJUSTMENT
POLICY IN WHICH HOSPITALS THAT TREAT A HIGH PERCENTAGE OF LOW INCOME PATIENTS RECEIVE INCREASED MEDICARE PAYMETNTS
DURABLE MEDICAL EQUIPMENT PROSTHETIC/ ORTHOTICS ADN SUPPLIES FEE SCHEDULE
MEDICARE REIMBRSES DEMPOS DEALEARS ACCORDING TO EITHER 80 PERCENT OF THE ACTUAL CHAREGE FOR THE ITEM OR THE FEE SCSHEDUAL AMOUNT WHICHEVER IS LOWER
END STAGE RENAL DISEASE COMPOSIT PAYMENT RATE SYSTEM
BUNDLES END STAGE RENAL DISEASE DRUGS AND RELATED LAB TESTS WITH THE COMPOSITE RATE PAYMENTS RESULTING IN ONE REIMBURSEMENT AMOUT PAID FOR ESRD SERVICES PROVIDED TO PATIENTS
EPISODE OF CARE HOME HEALTH
PERIOD OF TIME DURING WHICH HOME HEALTH CARE IS PROVIDED FOR A PARTICULAR CONDITION
FEDERALLY QUALIFIED HEALTH CENTER
SAFTEY NET PROVIDERS THAT PRIMARILY PROVIDE SERVICES TYPICALLY FURNISHED IN AN OUTPATIENT CLINIC
FEDERALLY QUALIFIED HEALTH CENTERS PROSPECTIVE PAYMENT SYSTEM
NATIONAL ENCOUNTER BASED RATE WITH GEOGRAPHIC AND OTHER ADJUSTMENTS ESTABLISHED BY THE AFFORADABLE CARE ACT AND I,PLENTED IN 2014
GLOBAL PAYEMENT
ONE PAYMENT TAHT COVERS ALL SERVICES RENDERED BY MULTIPLE PROVIDERS DURING AN EPISODE OF CARE
GROUPER SOFTWARE
DETERMINES APPROPRIATE GROUP GROUP HOME HEALTH RESOURCE GROUP AND SO ON TO CLASSIFY A PATIENT AFTER DATA ABOUT TEH PATIENT IS INPUT
HEALTH INSURANCE PROSPECTIVE PAYMENT SYSTEM CODE SET
FIVE DIGIT ALPHANUMERIC CODES TAHT REPRESENT CASE MIX GROUPS ABOU TWHICH PAYMENT DETERMINATIONS ARE MADE FOR HH PPS
HOME ASSESSMENT VALIDATION AND ENTRY
DATA ENTRY SOFTWARE USED TO COLLECT OASIS ASSESMETN DATA FOR TRANSMISSON TO STATE DATABASES
HOME HEALTH PATIENT DRIVEN GROUPINGS MODEL
IMPLEMENTED IN 20220 TO REPLAE HOME HEALTH RESOURCCE GROUPS RELIES MORE HEAVILY ON CLINICAL CHAREACTERISTICS ANDOTHE RPATIENT INFORMATION TO PLACE HOME HEALTH PERIODS OF CARE INTO MEANINGFUL PAYMETN CATGORIES ELIMINATED USE OF THERAPY SERVICES THRESHOLDS RESULTHED IN UNIT OF HOME HEALTH PAYMENT BEING REDUCED FOR 60 TO 30 DAY PERIOD
HOME HEALTH VALUE BASED PURCHASING MODEL
DESIGNED TO PROVIDE MEDICARE CERTIFIED HHAS WITH INCENTIVES TO PROVIDE HIGHER QUALITY AND MORE EFFICIENT CARE HHA PAYMENTS ARE ADJUSTED FOR SERVICES BASED ON QUALITY OF CARE
HOSPITAL ACQUIERED CONDITION HAC
MEDICAL CONDITIONS OR COMPLICATIONS THAT PATIENTS DEVELOP DURING INPATIENT HAOSPITAL STAYS AND THAT WERE NOT PRESENT AT ADMISSION