Medicare Reimbursement Methodologies Review
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Topics of this game:
- Resource measurement system that assigns values to services performed by physicians or other health professionals based on cost
- Provides reimbursement to physicians and other health professionals
- Services of physicians and other health professionals provided to Medicare beneficiaries are covered under:
- What percent of clinicians are in the Medicare registry?
- How many parts is the payment system divided into?
- What are the parts of the payment system?
- How does Centers for Medicare and Medicaid Services develop payment rates?
- The unit of measure
- What is the reimbursement methodology for Medicare Physician Fee Schedule (MPFS)?
- Is the Medicare Physician Fee Schedule a prospective payment system?
- What is the across-the-board multiplier that is used to convert the RVUs into reimbursement amounts?
- Can a physician increase reimbursements by increasing the volume of individual services provided to a patient?
- When did the MPFS become effective?
- How many components are payments to physicians based on?
- What are the components of the payments to physicians?
- What is used by physicians to report procedures, services, and supplies?
- Is each HCPCS assigned an RVU?
- How many elements is each RVU subdivided into?
- Each element has a unique weight.
- What is the total RVU weight of Physician work (WORK)?
- What is the percent of the total RVU weight for Practice expense (PE)?
- What is the percent of the total RVU weight for Malpractice (MP)?
- Where are the national averages located for WorK, PE, and MP?
- The element that covers the physician's salary:
- What are the four aspects of intensity of with which time is spent for WorK?
- Represents the overhead costs of running a health professional or physician practice:
- What kind of survey does the CMS conduct to obtain data to calculate the overhead costs of a practice?
- How many categories does the SMS include for the PE costs?
- Clinical payroll includes fringe benefits for non physician clinical personnel:
- Administrative payroll for non physician administrative personnel, including fringe benefits
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