Unit 8 Glossary

A patient classification system grouping inpatient stays by diagnosis, procedures, and demographics for fixed Medicare IPPS payment. Component of RBRVS measuring physician work, practice expense, and malpractice for calculating Medicare Part B payment. Federal statute prohibiting knowingly submitting false claims to the government; allows qui tam whistleblower lawsuits. Federal law prohibiting offering, paying, soliciting, or receiving anything of value to induce referrals of Medicare/Medicaid business. Physician Self-Referral Law — prohibits referrals for designated health services to entities in which the physician has a financial relationship. CMS contractors who review Medicare claims for improper payments (overpayments and underpayments). CMS program adjusting hospital payments based on quality performance and patient experience scores. The payment unit for hospital outpatient services under the Outpatient Prospective Payment System (OPPS).