Ms drg assignment - Study guides, Class notes & Summaries

CDIP Toolkit Questions and Answers Fully solved recent drivers of CDI (p2) - MS-DRGs 2007 to reflect SOI/ROM - POA indicators 2008 - Medicare Advantage/Part C (capitated, HCC) - some payers moving to APR DRGs - compliance reviews: RAC, Zone Program Integrity Contractors, Medicaid Integ Contractors purpose of CDI program (p2) to initiate concurrent and, as appropriate, retrospective reviews of health records for conflicting, incomplete, or nonspecific provider documentation. ...

The process of collecting data elements from a source document is known as: a. Extracting b. Mining c. Abstracting d. Drilling - Answer-Correct Answer: C Abstracting is the process of taking data elements from a source document to enter into an automated system (Sayles 2020, 70). What piece of claims data from Hospital A alerts a payer that the patient was transferred to Hospital B? a. Admission source b. Admit diagnosis c. Discharge disposition d. Discharge diagnosis - Answer-Correc...

A 23 year old female is admitted for vaginal bleeding following a miscarriage two weeks prior to this admission. She afebrile at this time and is treated with an aspiration dilation and curettage. Products of conception are found. Which of the following should be the principle diagnosis? a. O03.1, Delayed or excessive hemorrhage following incomplete spontaneous abortion b. O08.1, Delayed or excessive hemorrhage following ectopic and molar pregnancy c. R57.9, Shock, unspecified d. T81.10XA, P...

Calculate the following amounts for a participating provider who bills Medicare: Submitted charge (based on provider's regular fee for office visit) $ 75 Medicare physician fee schedule (PFS) $ 60 Coinsurance amount (paid by patient or supplemental insurance) $ 12 Medicare payment (80 percent of the allowed amount) $ ????? Medicare write-off (not to be paid by Medicare or the beneficiary) $ ????? correct answer: Medicare payment (80 percent of the allowed amount) $48 Medicare write-...

CCS Exam 2023/ 2024 | Questions and Answers (Verified Answers)| Grade A Q: Diagnostic-related groups (DRGs) and ambulatory patient classifications (APCs) are similar in that they are both: Answer: Prospective payment systems Q: Medicare exerts control of provider reimbursement through adjustment of this component of the resource-based relative value scale (RBRVS). Answer: Conversion factor Q: The process of collecting data elements from a source document is known as ...

IPPS - ANSWERinpatient prospective payment system OPPS - ANSWEROutpatient Prospective Payment System fee-for-service (FFS) - ANSWERa written fee schedule for each treatment and/or service provided MS-DRG - ANSWERMedicare Severity Diagnosis Related Group Case-Mix Index (CMI) - ANSWERthe average relative weight of all patients treated at a specific facility or by a specific physician to measure clinical severity or resource utilization Ambulatory patient classifications (APC) - AN...

CCS EXAM QUESTIONS AND ANSWERS Data, people, and process along with combination of hardware, software, and communications technology are components of a(n): - Answer-Information system Healthcare information exchanges facilitate: - Answer-Seamless transfer of patient care data Digital signatures are: - Answer-Cryptography that ensures a document is authentic All of the following are considered malicious software (malware) except: A. Computer virus B. Spyware C. Backdoor D. Bu...

CCS Exam Prep Medical Billing and Reimbursement Systems Questions and Answers 2024 1. The case-mix management system that utilizes information from the Minimum Data Set (MDS) in long-term care settings is called A. Medicare Severity Diagnosis Related Groups (MS-DRGs). B. Resource Based Relative Value System (RBRVS). C. Resource Utilization Groups (RUGs). D. Ambulatory Patient Classifications (APCs). C 2. The prospective payment system used to reimburse home health agencies for patients ...

1. Identify the CPT code for a 42-year-old diagnosed with ESRD who requires home dialysis for the month of April. a. 90965 b. 90964 c. 90966 d. 90970 - ANSWER-Correct Answer: C Dialysis, end-stage renal disease. Code 90966 is for end-stage renal disease (ESRD) related services for home dialysis per full month for patients 20 years of age and older (Smith 2012, 227). 2. Exceptions to the consent requirement include: a. Medical emergencies b. Provider discretion c. Im...

During an audit of health records, the HIM director finds that transcribed reports are being changed by the author up to a week after initial transcription. The director is concerned that changes occurring this long after transcription jeopardize the legal principle that documentation must occur near the time of the event. To remedy this situation, the HIM director should recommend which of the following? - Develop a facility policy that defines the acceptable period of time allowed for a transc...