Chapter 6 Review Quiz Essays

Chapter 6 Review Quiz Essays Chapter 6 Review Quiz Paper Chapter 6 Review Quiz Paper 1. List at least two major reasons that Medicare administrators turned to the prospec? ve payment concept for Medicare bene? ciaries. Medicare payments to hospitals grew, on average, by 19 percent annually (three ? mes the average overall rate of ina? on). The Medicare hospital deduc? ble expanded, crea? ng a burden for Medicare bene? ciaries. 2. How do MS-DRGs encourage inpa? ent facili? es to prac? ce cost management? Linking like pa? ents with like-resource consump? on allows hospitals to perform cost management by DRG or DRG groupings. 3. Why was a severity of illness re? nement performed on the DRG system? Was it supported by the healthcare community? The severity of illness re? nement allows cases with a higher severity of illness ranking to be more appropriately reimbursed. Yes, the re? nement was supported by the healthcare community. 4. List the steps of MS-DRG assignment. Pre-MDC Assignment, MDC Determina? on, Medical/Surgical Determina? on, and Re? nement. 5. Why does the IPF PPS length-of-stay adjustment factor grow smaller during the pa? ent encounter? Cost regression indicated that the per-diem cost for psychiatric cases decreased as the  length of stay increased 6. Describe at least two pa? ent-level adjustments for IPF PPS claims and explain why they are used. An adjustment was implemented for older pa? ents because regression analysis shows the cost per day as increasing with increasing pa? ent age. Another adjustment was implemented for pa? ents receiving electroconvulsive therapy, the cost of which is associated with longer stays and increased use of ancillary services. 7. What is the labor por? on of the IPF PPS per diem rate? What is the non-labor por? on of the IPF PPS per diem rate? Labor-related share is adjusted by the wage index for the hospitals geographic loca? on- based encore-based sta? s? cal areas (CBSAs). The non-labor share is modi? ed by a cost-of-living adjustment (COLA). 8. Why was the ini? al stay and readmission provision included in the IPF PPS? CMS did not want to provide an incen? ve for facili? es to prematurely discharge pa? ents and then subsequently re-admit them since the length of stay adjustment is weighted heavier for the beginning days for an admission. 9. Describe the medical necessity provision of the IPF PPS. Physician recer ca? on to establish con? nued need for inpa? ent psychiatric care is required on the 18th day [emailprotected] admission. 10. When performing the payment determina? on for IPF PPS admissions, which step comes ? rst: wage-index adjustment or applica? on of the pa? ent and facility-level adjustments? Wage-Index Adjustment