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Hospital Billing ch5
HC255 IPPS Class
Question | Answer |
---|---|
What is the Outpatient Prospective Payment System pricing unit that is comparable to DRGs for inpatient services? | ambulatory payment classification (APC) |
What are the three types of CCI edits? | Column 1/Column 2 Code Pair Edits Mutually Exclusive Edits Medically Unlikely Edits |
What is the difference between fraud and abuse? | Fraud is an intentional act of deception to take advantage of another person. Abuse is an action of misusing government allocated money; it is not necessarily intentional. |
What is a compliance plan? | a process for finding, correcting, and preventing illegal practices |
MDC is an abbreviation for | major diagnostic categories |
A software program used to assign DRGs | MS Grouper |
Conditions that develop as problems related to surgery or other treatments | complications |
Average of the DRG weights for all discharged patients during a certain time period is a hospital’s | case mix index (CMI) |
MCE is the abbreviation for: | Medicare Code Editor |
Medicare’s national policy on correct CPT coding | Correct Coding Initiative (CCI) |
Identification of services that could not have reasonably been done during a single patient encounter: | CCI mutually exclusive edits |
Programs that align financial incentives with the delivery of high-quality care: | pay-for-performance programs |