chapter 7 workbook

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Dec 6, 2023

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Principles of Healthcare Reimbursement and Revenue Cycle Management Student Workbook Chapter 7 Application and Data Analysis Exercises Application and data analysis exercises are provided at three levels of understanding. Basic exercises focus on Bloom’s Taxonomy levels 1 (remembering) and 2 (understanding). Intermediate exercises relate to Bloom’s Taxonomy levels 3 (applying) and 4 (analyzing). Advanced exercises are presented at Bloom’s Taxonomy levels 5 (evaluating) and 6 (creating). Intermediate and advanced exercises require critical thinking and analysis of data or scenarios. Beginner Exercises 1. Matching (Level 1—Remembering) Match the payment status indicator on the left with the description on the right. Reference table 7.1 for a listing of payment status indicators. Payment Status Indicator (SI) Answer Description A T APC payment reimbursement methodology: included in New Technology APCs, discounted when multiple of this SI appear on same claim, same day of service C J1 Comprehensive APC Payment: all services are packaged with this SI H N Packaged payment J1 K APC payment reimbursement methodology: drugs, biologicals and radiopharmaceuticals that are not pass- through eligible K Q1 Conditional APC payment: STV conditionally packaged services N C Inpatient only procedures Q1 Q4 Conditional APC payment or via the Clinical Lab Fee Schedule when applicable Q3 A Fee schedule payment: example is physical therapy Q4 S APC payment reimbursement methodology: included in New Technology APCs, multiple procedure reduction does not apply S V APC payment reimbursement methodology: emergency department encounters T H Reasonable cost reimbursement methodology: Pass- through devices with no copayment V Q3 Composite APC payment: APC 8004 Ultrasound
2. Chapter 7 PPS Grid (Level 2—Understanding) For this exercise use the Word file titled AB202019_Ch07_Payment System Grid.docx. Complete the grid by using information provided in the textbook. Include a brief explanation for each category rather than a “yes” or “no.” This grid may be used as a study guide for exams. Intermediate Exercises 1. Practice with APCs (Level 3—Interpreting) This assignment is designed to give the student practice with understanding APC concepts, groups, and payment rates. Students will use the most recent OPPS Addendum A and Addendum B. Addendums A and B are located at https://www.cms.gov/Medicare/Medicare-Fee-for-Service- Payment/HospitalOutpatientPPS/Addendum-A-and-Addendum-B-Updates . INSTRUCTIONS: Locate the most recent OPPS Addendum A and Addendum B on the Medicare website. 1. Using Addendum A, identify a set (example is Pathology) of surgical APCs that are paid at the full rate. Exclude New Technology. a. Set: Critical care (5041) or Trauma Response with Critical Care (5045) b. Status Indicator: S 2. Using Addendum A, identify a set (example is Airway Endoscopy) of surgical APCs that are paid at a discounted rate when multiple procedures are performed. Exclude New Technology. a. Set: Level 1 – 5 Skin procedures (5051-5055) b. Status Indicator: T 3. In Addendum A, locate APCs 5111-5116. APC 5111 is SI T and the remaining APCS are SI J1. How is SI J1 different from T? SI J1: the hospital services payment is through comprehensive APC and not paid separately. SI T: the payment is under OPPS and are paid separately. 4. Using Addendum B, locate five packaged codes/services from different areas of the code set (i.e., not all five from anesthesia). 1. X: 00100 - 00104 2. X: 00550 – 0055T 3. X: 43197 - 43200 Copyright ©2021 by the American Health Information Management Association. All rights reserved.
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