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Flashcards in EXAM 1 Deck (33)
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1
Q

Ambulance service entities associated with a medical facility
• Hospital, CAH, SNF

A

Ambulance Fee Service Entity – provider

2
Q

Ambulance service entities not associated with a medical facility
• Independent ambulance companies

A

Ambulance Fee Service Entity – supplier

3
Q

Set of Categories of patients (type and volume) treated by a healthcare organization and representing the complexity of the organizations case load

A

Case Mix

4
Q

what is the payment if patient dies prior to the ambulance being called?

A

BLS(Basic Life Support) base rate payment will be paid

5
Q

When was ambulance fee schedule implemented?

A

April 1, 2002

6
Q

How many MDC categories are there?

A

25

7
Q

Medical necessity via physician certification must be provided for which type of ambulance transport?

A

Nonemergency transport

8
Q

What is the basis for labor related share in IPF PPS?

A

Facilities costs related to payrolls, benefits, and professional fees

9
Q

Add up the total number of CMS Relative Weights and divide by the total number of patients.
123.6651 / 155 = 0.7978

A

Calculation of case mix index

10
Q

Multiply the “CMS Relative Weight” by the total number of cases (patients) in the MS DRG group.
11.6835 = (0.7789 x 15)

A

Calculating Total CMS Relative Weight

11
Q

DRGs system was implemented?

A

October 1, 1983 or 2007

12
Q
Basic life support 
advanced life support - level 1
advanced life support - level 2
specialty care transport 
paramedic als intercept 
fixed wing air ambulance 
rotary wing air ambulance
A

Ambulance levels of service

13
Q

emergency medical technician provides basic life support, including establishment of a peripheral intravenous line

A

Basic life support

14
Q

assessment provided by an advanced EMT or paramedic (ALS crew) to determine patient needs and the furnishing of one or more ALS interventions. An ALS intervention is a procedure beyond the scope of an EMT

A

Advanced life support - level 1

15
Q

administration of at least three different medications or the provision of one or more ALS procedures

A

Advanced life support - Level 2

16
Q

critically injured or ill patients, the level of interhospital service furnished is beyond the scope of a paramedic; next level care is provided by one or more healthcare professionals in an specialty care area

A

specialty care transport

17
Q

ALS services provided by an entity that does not provide an ambulance transport

A

Paramedic ALS intercept

18
Q

flight transport; destination is inaccessible by land vehicle or great distances or other obstacles and the patients condition is not appropriate for BLS or ALS ground transportation

A

Fixed wing air ambulance

19
Q

Helicopter transport; destination in accessible by land vehicle or great distances or other obstacles and the patients conditions are not appropriate for BLS or ALS ground transportation

A

Rotary wing air ambulance

20
Q

Uses a limited amount of equipment to perform initial assessments and interventions

A

First responders

21
Q

Knowledge and skill of a first responder but is also qualified to provide basic emergency medical care in the field, as the minimum staff for an ambulance

A

EMT

22
Q

Knowledge and skills identified at the first responder and EMT levels but is also qualified to perform essential advanced techniques and to administer a limited number of medications

A

Advanced EMT

23
Q

Has advanced skills and can administer additional interventions and medications

A

Paramedic

24
Q

Computer program using specific data elements to assign patients, clients, or residents to group, categories, or classes

A

Grouper

25
Q
Adjustment for geographic differences in cost
Each RVU category has a corresponding 
Based on “locality” or payment areas
Can be
Large metropolitan area
Boston or San Francisco
Portions of states
Rest-of-state areas
Entire state
A

GPCI – Geographic practice cost indexes

26
Q

Overhead costs of the practice
Clinical and administrative payroll, office expenses, medical material and supply costs, medical equipment costs
Two PE components: Facility (hospital); Nonfacility (physician office)

A

Practice expense in RBRVs

27
Q
Time required and intensity of procedure
Mental effort and judgment
Technical skill
Physical effort
Psychological stress
A

Work expense in RBRVs

28
Q
Assigned to HCPCS codes are a measure of resource utilization
There are 3 RVU categories
Work
PE
MP or PLI
A

Relative value units

29
Q

[(WORK RVU) (WORK GPCI) + (PE RVU) (PE GPCI) + (MP RVU) (MP GPCI)] = (SUM) × CF = Medicare Physician Fee Schedule (MPFS) Amount

Example: [(0.93) (0.990) + (1.11) (0.917) + (0.08) (1.005)] = (SUM) × $35.9996 = $72.66

A

RBRVs payment calculation

30
Q

How might a hospital increase their case mix?

A

create a task force or group of personnel for Clinical Documentation Improvement (CDI). The role of this group is not only to review all physician/clinician documentation for accuracy and to eliminate mistakes and lack of precision that impact billing and payments, but also to create processes that eliminate the most common mistakes made in documentation.

31
Q

How are payment rates established for IPPS?

A

base payment rate is multiplied by the DRG relative weight.

32
Q

Wage Adjustments - ($771.35 * 0.75 * 0.9716) + ($771.35 * 0.25)
$754.92
Multiply the adjustment factors together
1.17 * 0.99 * 1.10 * 1.06 * 1.05 = 1.4181
1.4181 * $754.92 = $1,070.55 (adjusted per diem amount)
Day 1 1.31 * $1,070.55 = $1,402.42
Day 2 1.12 $1,199.02
Day 3 1.08 $1,156.19
Day 4 1.05 $1,124.08
Day 5 1.04 $1,113.37
Total = $5,995.08

A

Patient level and facility level adjustments in IPF PPS

33
Q

daily publication of the US federal government that issues proposed and final administrative regulations of federal agencies. Including healthcare common coding systems

A

Federal register