Exam (elaborations)
MANAGING DRGS FOR REIMBURSEMENT QUESTIONS AND ANSWERS 2024/2025
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MANAGING DRGS FOR REIMBURSEMENT QUESTIONS AND ANSWERS 2024/2025
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2 0 2 4 /2025 | © copyright | This work may not be copied for profit gain Excel!MANAGING DRGS FOR
REIMBURSEMENT QUESTIONS AND
ANSWERS 2024/2025
The MS-DRG and APR-DRG establish a uniform cost for caring for a patient in each DRG.
Providers cannot keep any surplus of the DRG payment received.
→ False
MS-DRG payment is impacted, in a transfer DRG, when the patient:
→ - Discharges to a post-acute facility (LTACH, IRF, SNF) prior to the GMLOS for the
qualifying DRG
→ - Discharges to hospice prior to the GMLOS for the qualifying DRG
Which of the following is true regarding the PEPPER (Program for Evaluating Patterns
Electronic Report)?
→ It provides guidance on areas to focus auditing and monitoring to prevent improper
Medicare payments
The hospital DRG payment is reduced due to a patient short length of stay 9at least one day
less than the geometric mean length of stay for the MS-DRG). The patient is discharged to a
post-acute acare setting to receive clinically related care within 3 days of the hospital stay.
What is this type of DRG called?
→ Transfer DRG
When is it appropriate to use Condition Code 43?
→ When home health is started more than three days after discharge
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