American Health Information Management Association (AHIMA) Certification Practice Exam

Which type of hospital is not included in the Medicare acute-care prospective payment system?

1. Children's

2. Small community

3. Tertiary

4. Trauma

The correct answer is: Children's

The correct answer is children's hospitals, as they are specifically excluded from the Medicare acute-care prospective payment system. This system is designed to reimburse hospitals for the care of Medicare patients based on the classification of their diagnosis and the procedures performed, thereby promoting efficiency and cost-effectiveness. Children's hospitals typically provide specialized services geared towards pediatric care, which often includes a range of services that differ from the standard acute care model for adult patients. As a result, they operate under distinct reimbursement guidelines, which recognize the unique needs and complexities involved in treating pediatric populations. This exclusive designation allows children's hospitals to receive funding through different mechanisms that are more suitable for their specialized services. In contrast, small community hospitals, tertiary hospitals, and trauma centers are included in the Medicare acute-care payment system since they provide acute medical services aligned with the types of services accounted for in the prospective payment system. Each of these hospital types plays a significant role in delivering care that meets the Medicare standards for acute care, thereby making them subject to the reimbursement structure established by Medicare.