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Hospital Billing ch5

HC255 IPPS Class

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