QUESTION: 85

One reimbursement method that health plans can use for hospitals is the ambulatory payment classifications (APCs) method. APCs bear a resemblance to the diagnosis-related groups (DRGs) method of reimbursement. However, when comparing APCs and DRGs, one of the primary differences between the two methods is that only the APC method

is typically used for outpatient care
assigns a single code for treatment
applies to treatment received during an entire hospital stay
is considered to be a retrospective payment system

Answer(s): A

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QUESTION: 86

Four types of APCs are ancillary APCs, medical APCs, significant procedure APCs, and surgical APCs. An example of a type of APC known as

An ancillary APC is a biopsy
Amedical APC is radiation therapy
Asignificant procedure APC is a computerized tomography (CT) scan
Asurgical APC is an emergency department visit for cardiovascular disease

Answer(s): C

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QUESTION: 87

The Gladspell HMO has contracted with the Ellysium Hospital to provide subacute care to its plan members. Gladspell pays Ellysium by using a per diem reimbursement method.

The per diem reimbursement method will require Gladspell to pay Ellysium a

Fixed rate for each day a plan member is treated in Ellysium's subacute care facility
Discounted charge for all subacute care services given by Ellysium
Rate that varies depending on patient category
Fixed rate per enrollee per month

Answer(s): A

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QUESTION: 88

The Gladspell HMO has contracted with the Ellysium Hospital to provide subacute care to its plan members. Gladspell pays Ellysium by using a per diem reimbursement method.

If Gladspell's per diem contract with Ellysium is typical, then the per diem payment will cover such medical costs as

Laboratory tests
Respiratory therapy
Semiprivate room and board
Radiology services

Answer(s): C

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