QuestionQuestion

Answer the following questions:

1. PPSs were implemented to control the rising cost of health care.   
True
False
   
2. PPSs provide predetermined fixed payments to hospitals regardless of the charges accrued.
True
False
   
3. Two PPS systems implemented by CMS are the MS-DRG and APC systems.
True
False
   
4. Coding has a direct impact on reimbursement.
True
False
   
5. The major difference between a hospital-based ambulatory surgery center, and an independent ambulatory surgery center is that the independent ASC is not affiliated with or owned by a hospital.
True
False
      
6. IPPS MS-DRGs are based on the patient’s ____________ and the __________ required to treat the condition.
         
7. OPPS APCs are based on the _______________ performed.
         
8. Additional payment may be received for inpatient cases that require more resources to treat a patient’s condition. These situations are called ___________.
         
9. Hospitals may bill separately for observation services when a patient meets the following criteria: ___________________________.
               
10. The Uniform Hospital Discharge Data Set (UHDDS), Item 12, defines a ______________ procedure as one that is (1) surgical in nature, or (2) carries a procedural risk, or (3) carries an anesthetic risk, or (4) requires specialized training.

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1. PPSs were implemented to control the rising cost of health care.
True
False
Answer: True

Explanation: The principal goal of the prospective payment system (PPS) was to reduce cost by:
• ensuring beneficiaries’ access to high-quality care
• encouraging efficiency.

2. PPSs provide predetermined fixed payments to hospitals regardless of the charges accrued.
True
False
Answer: True

Explanation: In the prospective payment system, a predetermined payment level is established based primarily upon the patient's diagnoses and services performed. The hospital then receives a fixed set payment regardless of the actual services being performed....
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