Chapter 1
True or False
A premium is the amount of money that a policyholder or beneficiary must periodically pay an insurance company for healthcare coverage
True
How many types of healthcare coverage are there?
two
What part of the Medicare program does not include a premium?
Part A
When the rate is established for each day of admission it is called
per diem
What reimbursement methodology is used for SNF PPS?
case-rate
national health service model
What are the two types of healthcare coverages?
single coverage or family coverage
Medicaid is a joint program between ___ and ___ governments?
federal and state
When they contract with Medicare Advantage Payers to care for Medicare beneficiaries under Medicare Part C it is called
capitation
Which PDPM component of care is not adjusted by characteristics of the resident?
non-case-mix
What healthcare model is used in the United States?
Private Health Insurance Model
What is the period when applications are received and processed usually without evidence of insurability or waiting periods.
open enrollment period
What is Federal Employees' Compensation Act of 1916?
The act that set regulations for injured federal workers.
Which reimbursement methodology is used in IPPS?
case-rate methodology
What doesn't affect the CMG used in the SNF Services Payment System?
functional score or number of therapy hours per week
number of therapy hours per week
An employee paying for 40 percent of the insurance premium through payroll processing is an example of a transaction between __ and ___
patient; employer
deductible
Which part of Medicare is the managed care option?
Part C
What is a focus area of the Hospital Readmissions Reduction Program?
Acute Myocardial Infarction
True or False
Bundling is when reimbursement for minor ancillary services associated with a significant procedure is combined into a single payment for the procedure
false
The goal of revenue integrity is to produce a claim that is
clean, complete, and compliant
Initial clinical review, peer clinical review, and appeals consideration are apart of what?
utilization review
Which part of Medicare covers prescription drugs?
Part D
The CMS-HCC model uses what two things to predict the patient's healthcare costs.
patient demographic characteristics and health status
Name one provision of OPPS
Interrupted services
High-cost outlier
Rural hospital adjustment
Cancer hospital adjustment
Pass-through payment policy