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AHIMA CCA: Reimbursement Methodologies /Questions And Answers Updated
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AHIMA CCA: Reimbursement Methodologies/Questions And Answers Updated 2023-2024
Quiz :1. Given the following information, which of the following statements is
correct?
191, MCD: 04, Type: MED MS-DRG, Title: Chronic obstructive pulmonary disease
w/ CC, Weight: 0.9757, Discharges: 10, Geometric Mean: 4.1, Arithmetic Mean:
5.0,
192, MCD: 04, Type: COPD w/o CC/MCC, Weight: 0.7254, Discharges: 20,
Geometric Mean: 3.3, Arithmetic Mean: 4.0
193, MCD: 04, Type: MED, Weight: Simple pneumonia & pleurisy w/ MCC, Weight:
1.4327, Discharges: 10, Geometric Mean: 5.4, Arithmetic Mean: 6.7
194, MCD: 04, Type: MED, MS-DRG Title: Simple pneumonia & pleurisy w/ CC,
Weight: 1.0056, Discharges: 20, Geometric Mean: 4.4, Arithmetic Mean: 5.3
195, MCD: 04, Type: MED, MS-DRG Title: Simple pneumonia & pleurisy w/o
CC/MCC, Weight: 0.7316, Discharges: 10, Geometric Mean: 3.5, Arithmetic Mean:
4.1
a. In each MS-DRG the geometric mean is lower than the arithmetic mean.
b. In each MS-DRG the arithmetic mean is lower than the geometric mean.
c. The higher the number of patients in each MS-DRG, the greater the geometric
mean for that MS-DRG.
d. The geometric means are lower in MS-DRGs that are associated with a CC or
MCC. - Answer :a. In each MS-DRG the geometric mean is lower than the
arithmetic mean.
The GEOMETRIC MEAN LOS is define as the total days of service, excluding any
outliers or transfers, divided by the total number or patients.
, Quiz :2. If another status T procedure were performed, how much would the
facility receive for the second status T procedure?
998323-billing#, V-status indicator, 99285-25-CPT/HCPCS, 0612-APC.
998324-billing#, T-status indicator, 25500-CPT/HCPCS, 0044-APC.
998325-billing#, X-status indicator, 72050-CPT/HCPCS, 0261-APC.
998326-billing#, S-status indicator, 70450-CPT/HCPCS, 0283-APC.
998327-billing#, S-status indicator, 70450-CPT/HCPCS, 0283-APC
a. 0%
b. 50%
c. 75%
d. 100% - Answer :b. 50%
Multiple surgical procedures with payment status indicator T performed during
the same operative session are discounted. The highest-weighted procedure is
fully reimbursed. All other procedures with payment status indicator T are
reimbursed at 50%.
Quiz :3. A health information technician is processing payments for hospital
outpatient services to be reimbursed by Medicare for a patient who had two
physician visits, underwent radiology examinations, clinical laboratory tests, and
who received take-home surgical dressings. Which of the following services is
reimbursed under the outpatient prospective payment system?
a. Clinical laboratory tests
b. Physician office visits
c. Radiology examinations
d. Take-home surgical dressings - Answer :c. Radiology examinations
Radiology procedures are identified under the outpatient perspective payment
system with a status indicator X. Status indicator X identifies ancillary services
that are separately paid .
, Quiz :4. Which of the following types of hospitals are excluded from the Medicare
inpatient prospective payment system?
a. Children's
b. Rural
c. State supported
d. Tertiary - Answer :a. Children's
Psychiatric and rehabilitation hospitals, long-term care hospitals, children's
hospitals, cancer hospitals, and critical access hospitals are paid on the basis of
reasonable cost, subject to payment limits per discharge or under separate PPS.
Quiz :5. Diagnosis-related groups are organized into:
a. Case-mix classifications
b. Geographic practice cost indices
c. Major diagnostic categories
d. Resource-based relative values - Answer :c. Major diagnostic categories
Diagnosis-related groupings [DRGs] are classified by one of 25 major diagnostic
categories [MDCs].
Quiz :6. In processing a Medicare payment for outpatient radiology examinations,
a hospital outpatient services department would receive payment under which of
the following?
a. DRGs
b. HHRGs
c. OASIS
d. OPPS - Answer :d. OPPS
RADIOLOGY PROCEDURES performed as outpatients are paid under the Medicare
prospective payment system and are identified with a status indicator X for
ancillary services.
Quiz :7. Which of the following is NOT reimbursed according to the Medicare
outpatient prospective payment system?
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