Revenue Chapter 6 CYU
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Discuss 2 of the 4 guiding principals of prospective payment.
1) Payment rates are to be established in advance & fixed for the fiscal period to which they apply. 2) Prospective payment rates are considered to be paid in full.
In the 4 step MS-DRG assignment process, if a coder is able to assign the MS-DRG in step 1, the pre-MDC assignment, all subsequent steps in the process are _____.
List 2 refinement questions that help coders group together patients with like resource consumption?
1) Is the principal diagnosis complicated? 2) Is a major complication or complex diagnosis present?
How are Medicare base payment rates increased to reflect inflation?
They use the market basket which is a combination of the current wage index & the cost of living adjustment.
How is the discharge disposition used in the execution of PACT payment?
They treat it as a type 1 transfer instead of a type 2 transfer if all of the criteria is met.
Which piece of legislation charged CMS with creating a PPS for the inpatient psychiatric setting & what requirements were included in the law?
The Balance Budget Refinement Act of 1999 The system would reflect the resource consumption & cist differences between the various IPFs & it would be budget neutral.
What type of budget scheme is used in the IPF PPS?
A per diem system with adjustments
What is the formula for the ECT adjustment for a facility with a wage index of .9812?
(ECT payment X wage % X .9812) + (ECT payment X non-labor %)
What are 2 categories of adjustments in IPF PPS?
facility & patient
List and discuss 2 if the provisions of the IPF PPS?
1) Initial Stay & Readmission Provision 2) Medical Necessity Provision
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