American Health Information Management Association (AHIMA) Certification Practice Exam

What payment system replaced the CPR payment system for Medicare in 1992?

1. Diagnosis-related groups

2. Resource-based relative value scale system

3. Long-term care drugs

4. Resource utilization groups

The correct answer is: Resource-based relative value scale system

The payment system that replaced the CPR (Comprehensive Per Diem Rate) system for Medicare in 1992 is the Resource-Based Relative Value Scale (RBRVS) system. This model shifted the focus from a flat rate to a more nuanced approach in which payment rates are determined based on the relative value of medical services provided, taking into account the complexity and resources required for each type of service. The RBRVS was designed to ensure that payments are more closely aligned with the actual work and costs involved in delivering healthcare services, thereby promoting fairness and efficiency in the reimbursement process. In contrast, other systems mentioned do not correctly represent what replaced the CPR system. Diagnosis-related groups (DRGs) were primarily used for inpatient hospital services but were not directly related to the CPR transition for Medicare in outpatient settings. Long-term care drugs and resource utilization groups (RUGs) pertain specifically to long-term care and other aspects of Medicare but do not address the comprehensive payment structure established by the RBRVS. Thus, the RBRVS's introduction marked a significant development in Medicare's payment methodologies by providing a more detailed and equitable basis for reimbursing healthcare providers.