IBHRE CCDS
CCDS Exam Questions with Correct
Solutions 2026
What does MS-DRG stand for?
Medicare Severity Diagnosis Related Group - payment system that classifies hospital
cases into groups with similar clinical characteristics and costs
What is the IPPS?
Inpatient Prospective Payment System - Medicare's method of reimbursing hospitals a
predetermined fixed amount based on the patient's DRG assignment
What is a Major Complication/Comorbidity (MCC)?
A secondary diagnosis that significantly increases resource use and is associated with a
higher payment weight (highest severity level)
What is a Complication/Comorbidity (CC)?
A secondary diagnosis that moderately increases resource use and payment weight
(moderate severity level)
What does APR-DRG stand for?
All Patient Refined Diagnosis Related Group - classification system used primarily for
non-Medicare populations and quality reporting
How many severity of illness (SOI) levels exist in APR-DRG?
Four levels: 1-Minor, 2-Moderate, 3-Major, 4-Extreme
How many risk of mortality (ROM) levels exist in APR-DRG?
Four levels: 1-Minor, 2-Moderate, 3-Major, 4-Extreme
What is the difference between SOI and ROM?
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,IBHRE CCDS
SOI measures extent of physiologic decompensation/organ system loss of function;
ROM measures likelihood of dying
What is GMLOS?
Geometric Mean Length of Stay - calculated measure that reduces impact of statistical
outliers; used for payment calculations
What is AMLOS?
Arithmetic Mean Length of Stay - simple average of all lengths of stay; used for
statistical reporting
What is the DRG relative weight?
A numerical value assigned to each DRG representing the average resources required
to treat patients in that group compared to the national average (1.0)
What is a Medicare Severity DRG?
A DRG classification that accounts for the presence or absence of CCs and MCCs,
creating three payment tiers for many base DRGs
What is case mix index (CMI)?
The average DRG weight for all cases in a hospital, reflecting the overall severity and
resource intensity of patients treated
What is the principal diagnosis?
The condition established after study to be chiefly responsible for occasioning the
admission of the patient to the hospital (UHDDS definition)
What does UHDDS stand for?
Uniform Hospital Discharge Data Set - standardized data elements and definitions for
inpatient reporting
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,IBHRE CCDS
What is a Major Diagnostic Category (MDC)?
One of 25 mutually exclusive diagnosis areas corresponding to a single organ system or
etiology used to organize DRGs
What MDC number is assigned to Diseases and Disorders of the Nervous System?
MDC 01
What MDC contains Diseases and Disorders of the Circulatory System?
MDC 05
What is a Pre-MDC DRG?
High-resource procedures that bypass typical DRG logic and assign directly (e.g., heart
transplant, tracheostomy with MV 96+ hours, ECMO)
What is DRG optimization?
The legitimate practice of ensuring all documented conditions are accurately coded to
reflect true resource consumption and severity
What is the base payment rate in IPPS?
The standardized amount established by CMS, adjusted for geographic wage
differences, used as the starting point for DRG payment calculation
What is an outlier payment?
Additional payment made when a case has extraordinarily high costs exceeding the
standard DRG payment plus a fixed-loss threshold
What is the outlier threshold for 2026?
Approximately $32,000 above the DRG payment (subject to annual CMS updates)
What is a transfer DRG?
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, IBHRE CCDS
Specific DRGs subject to per diem payment reductions when patients are transferred to
another acute care facility
What is POA?
Present On Admission - indicator (Y/N/U/W/1) that identifies whether a diagnosis was
present at the time of inpatient admission
Why is POA important?
CMS uses POA to distinguish conditions present at admission from hospital-acquired
conditions for payment and quality reporting purposes
What does POA indicator "Y" mean?
Yes - diagnosis was present at the time of inpatient admission
What does POA indicator "N" mean?
No - diagnosis was not present at the time of inpatient admission (developed during the
stay)
What does POA indicator "U" mean?
Unknown - documentation is insufficient to determine if condition was present on
admission
What does POA indicator "W" mean?
Clinically undetermined - provider is unable to clinically determine whether condition
was present on admission
What does POA indicator "1" mean?
Unreported/Not Used - exempt from POA reporting (applied to certain diagnosis codes)
What is the primary difference between MS-DRG and APR-DRG?
4|Pagέ
CCDS Exam Questions with Correct
Solutions 2026
What does MS-DRG stand for?
Medicare Severity Diagnosis Related Group - payment system that classifies hospital
cases into groups with similar clinical characteristics and costs
What is the IPPS?
Inpatient Prospective Payment System - Medicare's method of reimbursing hospitals a
predetermined fixed amount based on the patient's DRG assignment
What is a Major Complication/Comorbidity (MCC)?
A secondary diagnosis that significantly increases resource use and is associated with a
higher payment weight (highest severity level)
What is a Complication/Comorbidity (CC)?
A secondary diagnosis that moderately increases resource use and payment weight
(moderate severity level)
What does APR-DRG stand for?
All Patient Refined Diagnosis Related Group - classification system used primarily for
non-Medicare populations and quality reporting
How many severity of illness (SOI) levels exist in APR-DRG?
Four levels: 1-Minor, 2-Moderate, 3-Major, 4-Extreme
How many risk of mortality (ROM) levels exist in APR-DRG?
Four levels: 1-Minor, 2-Moderate, 3-Major, 4-Extreme
What is the difference between SOI and ROM?
1|Pagέ
,IBHRE CCDS
SOI measures extent of physiologic decompensation/organ system loss of function;
ROM measures likelihood of dying
What is GMLOS?
Geometric Mean Length of Stay - calculated measure that reduces impact of statistical
outliers; used for payment calculations
What is AMLOS?
Arithmetic Mean Length of Stay - simple average of all lengths of stay; used for
statistical reporting
What is the DRG relative weight?
A numerical value assigned to each DRG representing the average resources required
to treat patients in that group compared to the national average (1.0)
What is a Medicare Severity DRG?
A DRG classification that accounts for the presence or absence of CCs and MCCs,
creating three payment tiers for many base DRGs
What is case mix index (CMI)?
The average DRG weight for all cases in a hospital, reflecting the overall severity and
resource intensity of patients treated
What is the principal diagnosis?
The condition established after study to be chiefly responsible for occasioning the
admission of the patient to the hospital (UHDDS definition)
What does UHDDS stand for?
Uniform Hospital Discharge Data Set - standardized data elements and definitions for
inpatient reporting
2|Pagέ
,IBHRE CCDS
What is a Major Diagnostic Category (MDC)?
One of 25 mutually exclusive diagnosis areas corresponding to a single organ system or
etiology used to organize DRGs
What MDC number is assigned to Diseases and Disorders of the Nervous System?
MDC 01
What MDC contains Diseases and Disorders of the Circulatory System?
MDC 05
What is a Pre-MDC DRG?
High-resource procedures that bypass typical DRG logic and assign directly (e.g., heart
transplant, tracheostomy with MV 96+ hours, ECMO)
What is DRG optimization?
The legitimate practice of ensuring all documented conditions are accurately coded to
reflect true resource consumption and severity
What is the base payment rate in IPPS?
The standardized amount established by CMS, adjusted for geographic wage
differences, used as the starting point for DRG payment calculation
What is an outlier payment?
Additional payment made when a case has extraordinarily high costs exceeding the
standard DRG payment plus a fixed-loss threshold
What is the outlier threshold for 2026?
Approximately $32,000 above the DRG payment (subject to annual CMS updates)
What is a transfer DRG?
3|Pagέ
, IBHRE CCDS
Specific DRGs subject to per diem payment reductions when patients are transferred to
another acute care facility
What is POA?
Present On Admission - indicator (Y/N/U/W/1) that identifies whether a diagnosis was
present at the time of inpatient admission
Why is POA important?
CMS uses POA to distinguish conditions present at admission from hospital-acquired
conditions for payment and quality reporting purposes
What does POA indicator "Y" mean?
Yes - diagnosis was present at the time of inpatient admission
What does POA indicator "N" mean?
No - diagnosis was not present at the time of inpatient admission (developed during the
stay)
What does POA indicator "U" mean?
Unknown - documentation is insufficient to determine if condition was present on
admission
What does POA indicator "W" mean?
Clinically undetermined - provider is unable to clinically determine whether condition
was present on admission
What does POA indicator "1" mean?
Unreported/Not Used - exempt from POA reporting (applied to certain diagnosis codes)
What is the primary difference between MS-DRG and APR-DRG?
4|Pagέ
