Revenue Chapter 6 Review Quiz
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List at least 2 major reasons why Medicare administrators turned to the prospective payment concept for Medicare beneficiaries.
Extreme rising costs which were higher than the current inflation rate & they needed to standardize costs across the board.
How do MS-DRGs encourage inpatient facilities to practice cost management?
Payments are fixed & if they are not making a profit at that price, then the facility may need to reevaluate things on their end.
Describe at least 2 patient level adjustments for IPF PPS claims and explain why they are used.
Age-the cost of care goes up with the age of the patient, a lot of elderly patients need more care than a younger patient. Health issues-a patient with other health problems besides the one they are being treated for cost more because the other problems have to be treated as well as the current problem.
What is the labor portion of the IPF PPS per diem rate?
0.69294 nearly 70%
What is the non-labor portion of the IPF PPS per diem rate?
0.30706 a little over 30%
Why are the initial stay & readmission provision in the IPF PPS?
To keep facilities from discharging a patient early & then readmitting the patient at the higher rate. The per diem goes down with each consecutive day.
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