HC255 IPPS Class
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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| What is the Outpatient Prospective Payment System pricing unit that is comparable to DRGs for inpatient services? | ambulatory payment classification (APC)
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| What are the three types of CCI edits? | Column 1/Column 2 Code Pair Edits Mutually Exclusive Edits Medically Unlikely Edits
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| 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.
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| What is a compliance plan? | a process for finding, correcting, and preventing illegal practices
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| MDC is an abbreviation for | major diagnostic categories
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| A software program used to assign DRGs | MS Grouper
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| Conditions that develop as problems related to surgery or other treatments | complications
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| Average of the DRG weights for all discharged patients during a certain time period is a hospital’s | case mix index (CMI)
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| MCE is the abbreviation for: | Medicare Code Editor
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| Medicare’s national policy on correct CPT coding | Correct Coding Initiative (CCI)
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| Identification of services that could not have reasonably been done during a single patient encounter: | CCI mutually exclusive edits
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| Programs that align financial incentives with the delivery of high-quality care: | pay-for-performance programs
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