Coding - MS-DRGs and IPPS Questions + Answers Graded A+
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Module
Coding - MS-DRGs and IPPS
Institution
Coding - MS-DRGs And IPPS
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 ...
Coding - MS-DRGs and IPPS
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 EMTALA cases
o Performance of expedited determinations
o Provider education on quality of care issues
DRGs - ✔️✔️payment rates to hospitals established before services are rendered.
For fiscal year 2008, Medicare adopted a severity adjusted diagnosis related group
system called? - ✔️✔️Medicare Severity DRGs (MS-DRGs)
The goal of of MS-DRG was? - ✔️✔️to significantly improve Medicare's ability to
recognize severity of illness in its inpatient hospital payments.
One MS-DRG is assigned to each acute care hospital stay.
MS-DRG is a prospective payment system
The formula for computing the hospital payment for each MS-DRG is: - ✔️✔️DRG
relative weight x hospital base rate = hospital payment
Add-on payment, AKA disproportionate share hospital adjustment does what? -
✔️✔️provides a percentage increase in Medicare payments to hospitals that qualify
under either of two statutory formulas designed to identify hospitals that serve a
disproportionate share of low-income patients.
IME or indirect medical education provides what? - ✔️✔️a percentage add-on payment
for each medicare discharge paid under IPPS.
• In addition to the basic payment rate, Medicare provides for an additional payment to
certain hospitals for other factors - ✔️✔️o Disproportionate share hospital (DSH)
adjustment
o Indirect medical education (IME) adjustment
o New technologies or medical services approved special add-on payments
o Outlier payment
Some categories of hospitals are paid the higher of a hospital-specific rate based on
their costs in a base year
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