Reimbursement rates based on the anticipated care needs of patients result in reduced risks to facilities and to payers. Health care facilities and payers determine anticipated care needs by reviewing types and/or categories of patients treated by a facility as part of __________ management.

a. chargemaster

b. capitation

c. case-mix

d. claims

#50 Which is a case-mix reimbursement system that connects payment to patients' conditions and care needs instead of the volume of services provided and that impacts intermediate care facilities, long term acute care facilities, and skilled nursing facilities?

a. pay-for-performance system

b. all-patient diagnosis-related groups

c. patient-driven payment system

d. IPPS 72-hour window rule

Examples of POS include:

a. wheelchairs, hospital beds, or portable IV pumps

b. cardiovascular, oncologic, or pediatric patients

c. doctor's offices, hospitals, or nursing facilities

d. surgeons, nurse practitioners, or therapists

Pay-for-performance (P4P) initiatives link reimbursement to health care performance criteria to promote the right care for every patient every time, regardless of a patient's ethnicity, gender, geographic location, and socioeconomic status, patients receive “right care." Which is an example of a P4P initiative?

a. Medicare physician fee schedule

b. hospital inpatient prospective payment system

c. intensity of services and severity of illness

d. hospital value-based purchasing program