Drg - Study guides, Class notes & Summaries

Steps used to control costs of managed care include: correct answers Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify correct answers Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred Identify the various types of private health plan coverage correct answers HMO Conventional PPO and POS HDHP/SO plans - high-deductible health...

medicare code edits: - ️️A method to identify various situations based upon assigned ICD-10-CM codes. For example, the sex conflict edit identifies situations when a female only diagnosis code is on a claim indicating the patient is a male. hospital wage index: - ️️A numeric factor defined by Medicare that considers the geographic location of hospitals. This factor is used in the reimbursement calculations for facilities to account for geographic differences. DRGs - ️️In 1983, ...

NRNP 6675-15; NRNP 6675 Week 6 Midterm Exam 2024/25 100% solved -Graded A+ NRNP 6675 Midterm Exam (Latest-2024/2025, 100 Q & A) / NRNP 6675N Midterm Exam / NRNP6675 Midterm Exam / NRNP-6675N Midterm Exam: Walden University | 100% Verified Q & A | Which of the following are risk factors for neuroleptic malignant syndrome? Select all that apply Age Rapid dose escalation Parental route of administration Higher potency typical antipsychotics 2. Antipsychotic medications provide D2 blockade in the ...

What effect does the addition of a patient who is a pack-a-day smoker have on the DRG assignment when viral pneumonia is the principal diagnosis? - ️️no effect on the DRG Which of the following coding rules might affect the ethical and appropriate assignment of the principal diagnosis and DRG for this case? Select all that apply. - ️️1. Respiratory failure is always due to an underlying condition. 2. Careful review of the medical record is required for accurate coding and sequencin...

medicare code edits - ️️a method to identify various situations based upon assigned ICD-10-CM codes hospital wage index - ️️a numeric factor defined by medicare that considers the geographic location of hospitals. this factor is used in the reimbursement calculations for facilities to account for geographic differences CC - ️️abbreviation for complications and comorbid conditions comorbid condition - ️️a pre-existing condition which, because of it's presence, causes an in...

Quality Improvement Organizations (QIOs) perform review services such as: - ️️o Quality of care reviews due to beneficiary complaints, complaints other than from beneficiaries and quality of care reviews referred by CMS or CMS designated entities o Utilization reviews for hospital requested higher weighted diagnosis related group (DRG) payments.o Utilization reviews referred by CMS or CMS designated entities for cases involving issues such as transfers and readmissions o Review of EMTA...

Close the DRG summary and drag the C18.7 down to the second position in the code screen. Which coding message do you receive? (Return the C18.7 code to the primary position after reviewing your answer.) - ️️The DRG may change as a result of reordering. What is the MS-DRG title? - ️️Digestive malignancy W/O CC/MCC Has the DRG assignment changed from the prior case? - ️️Yes The MS-DRG title/assignment would not include the: - ️️Pylorus Code D62. Which of the following is tru...

NRNP 6675-15 Week 6 MIDTERM EXAM 2023/2024 ACTUAL QUESTIONS AND ANSWERS GRADED A+ 1. Which of the following are risk factors for neuroleptic malignant syndrome? Select all that apply  Age  Rapid dose escalation  Parental route of administration  Higher potency typical antipsychotics 2. Antipsychotic medications provide D2 blockade in the mesocortical pathway causing which of the following effects?  Reduces negative symptoms  Increases extra pyramidal symptoms (EP...

Medicare Hospital Acute Inpatient Payment System Chapter 5 Graded A+ What is the primary purpose of the Medicare Hospital Acute Inpatient Payment System? The primary purpose of the Medicare Hospital Acute Inpatient Payment System is to reimburse hospitals for the costs associated with inpatient care for Medicare beneficiaries. How are payments determined under the Medicare Hospital Acute Inpatient Payment System? Payments are determined using a diagnosis-related group (DRG) system, w...

Access to healthcare Correct Answer-An individual's ability to obtain appropriate health care services is described as either potential (supply) or actual (demand); described degree of fit between client and health system Diagnostic related grouping (DRG) Correct Answer-DRG is a patient classification system used by hospitals to bill and be paid by third party payers. The payment is based on the average cost for the patient's DRG. Patients are assigned to a DRG based upon the patient's dia...