Validating Data

To implement the OPPS, Medicare assigns a payment status indicator (SI) for every
A.ICD-9-CM procedure code.
B.HCPCS and CPT code.
C.APC.
D.DRG.

Documentation of the "approach" of a surgical procedure would be necessary to assign most
A. ICD-9-CM diagnosis codes
B. .DRGs.
C. APCs.
D. CPT codes.

Critical care CPT codes are based on
A. physician time.
B. IV infusion time.
C. procedure approach.
D. diagnosis.

Medicare Part A pays for
A. physician-related services.
B. prescription drugs.
C. inpatient hospitalization.
D. medical coverage for active-duty and retired service members.

ICD-9-CM diagnosis codes are NOT required for determining
A. rehabilitation PPS.
B. APC assignment.
C. DRG assignment.
D. home health PPS.

Codes for drugs, pharmaceuticals, and biologicals often begin with
A. a letter.
B. number.
C. decimal point.
D. asterisk.

What Medicare organization serves as the financial agent between the providers and the federal government in the local administration?
A. risk management
B. Department of Health and Human Services
C. Office of the Inspector General
D. Medicare administrative contractors

In order for an inpatient rehabilitation facility to be reimbursed via the prospective payment system, what must be completed and entered into grouper software?
A. PAI
B. DRG
C. consent form
D. APC

Major diagnostic categories (MDCs) are divided into groups based on
A. medical and surgical categories.
B. secondary diagnoses.
C. discharge disposition.
D. lengths of stay (LOS).

MS-DRGs are different than DRGs in that they take into account
A. discharge disposition.
B. the approach of a procedure.
C. complications and comorbidities.
D. severity of illness.

What has the potential to increase the relative weight of a diagnosis-related group (DRG)?
A. IV infusion
B. CC
C. chest X-ray
D. LOS

Medicare outpatient prospective payment system (PPS) is based on
A. IRF-PAI.
B. E/M levels.
C. APCs.
D. DRGs.

What variable is NOT taken into account when assigning a diagnosis-related group (DRG)?
A. Gender
B. discharge disposition
C. length of stay
D. age

DRGDRG DescriptionRelative Weight# Patients
374Digestive Malignancy w/MCC1.9007
375Digestive Malignancy w/ CC1.25015
376Digestive Malignancy w/o CC/MCC.882025
377GI Hemorrhage w/ MCC1.6001014.
Using the table above, what DRG would provide the most reimbursement based on the patient population?
377
376
374
375

DRGDRG DescriptionRelative Weight# Patients
374Digestive Malignancy w/ MCC1.9007
375Digestive Malignancy w/ CC1.25015
376Digestive Malignancy w/o CC/MCC.882025
377GI Hemorrhage w/ MCC1.6001015.
Using the table above, what is the CMI for this group of patients? You are expected to use a calculator for this scenario.
A. 1.900
B. 1.408
C. 1.250
D. 1.229

A POA indicator on all diagnosis codes is required on all
A. inpatient encounters.
B. emergency room visits.
C. inpatient psychiatric admissions.
D. inpatient rehabilitation admissions.

How many diagnosis-related groups (DRGs) can be assigned for an inpatient encounter?
A. 1
B. 2
C. 3
D. 4

What organization is responsible for the maintenance of coding clinics for ICD-9-CM?
A. NCHS
B. CMS
C. AHA
D. AHIMA

What type of reimbursement is a diagnosis-related group (DRG)?
A. fee for service
B. prospective payment system
C. fee schedule
D. capitation

When is a physician query appropriate?
A. if there is an abnormal lab finding not correlated in the documentation
B. when the discharge summary is not complete
C. for every discrepancy not addressed in the physician documentation
D. when there is conflicting information in the record

What Medicare organization serves as the financial agent between the providers and the federal government in the local administration?
A. Department of Health and Human Services
B. risk management
C. Medicare administrative contractors
D. Office of the Inspector General

Critical care CPT codes are based on
A. physician time.
B. IV infusion time.
C. diagnosis.
D. procedure approach.

MS-DRGs are different than DRGs in that they take into account
A. complications and comorbidities.
B. the approach of a procedure.
C. discharge disposition.
D. severity of illness.

ICD-9-CM diagnosis codes are NOT required for determining
A. APC assignment.
B. home health PPS.
C. DRG assignment.
D. rehabilitation PPS.