AHIMA CCA – REIMBURSEMENT METHODOLOGIES 2026/2027 – STUDY GUIDE,
PRACTICE QUESTIONS & EXAM REVIEW
1. Given the following information, which of the following statements is correct?
191, MCD: 04, Type: MED MS-DRG, Title: Chronic obstructive pulmonary disease w/ CC, Weight: 0.9757,
Discharges: 10, Geometric Mean: 4.1, Arithmetic Mean: 5.0,
192, MCD: 04, Type: COPD w/o CC/MCC, Weight: 0.7254, Discharges: 20, Geometric Mean: 3.3,
Arithmetic Mean: 4.0
193, MCD: 04, Type: MED, Weight: Simple pneumonia & pleurisy w/ MCC, Weight: 1.4327, Discharges:
10, Geometric Mean: 5.4, Arithmetic Mean: 6.7
194, MCD: 04, Type: MED, MS-DRG Title: Simple pneumonia & pleurisy w/ CC, Weight: 1.0056,
Discharges: 20, Geometric Mean: 4.4, Arithmetic Mean: 5.3
195, MCD: 04, Type: MED, MS-DRG Title: Simple pneumonia & pleurisy w/o CC/MCC, Weight: 0.7316,
Discharges: 10, Geometric Mean: 3.5, Arithmetic Mean: 4.1
a. In each MS-DRG the geometric mean is lower than the arithmetic mean.
b. In each MS-DRG the arithmetic mean is lower than the - ANS ✔✔a. In each MS-DRG the geometric
mean is lower than the arithmetic mean.
The GEOMETRIC MEAN LOS is define as the total days of service, excluding any outliers or transfers,
divided by the total number or patients.
2. If another status T procedure were performed, how much would the facility receive for the second
status T procedure?
998323-billing#, V-status indicator, 99285-25-CPT/HCPCS, 0612-APC.
998324-billing#, T-status indicator, 25500-CPT/HCPCS, 0044-APC.
998325-billing#, X-status indicator, 72050-CPT/HCPCS, 0261-APC.
998326-billing#, S-status indicator, 70450-CPT/HCPCS, 0283-APC.
998327-billing#, S-status indicator, 70450-CPT/HCPCS, 0283-APC
a. 0%
b. 50%
c. 75%
d. 100% - ANS ✔✔b. 50%
, Multiple surgical procedures with payment status indicator T performed during the same operative
session are discounted. The highest-weighted procedure is fully reimbursed. All other procedures with
payment status indicator T are reimbursed at 50%.
3. A health information technician is processing payments for hospital outpatient services to be
reimbursed by Medicare for a patient who had two physician visits, underwent radiology examinations,
clinical laboratory tests, and who received take-home surgical dressings. Which of the following services
is reimbursed under the outpatient prospective payment system?
a. Clinical laboratory tests
b. Physician office visits
c. Radiology examinations
d. Take-home surgical dressings - ANS ✔✔c. Radiology examinations
Radiology procedures are identified under the outpatient perspective payment system with a status
indicator X. Status indicator X identifies ancillary services that are separately paid .
4. Which of the following types of hospitals are excluded from the Medicare inpatient prospective
payment system?
a. Children's
b. Rural
c. State supported
d. Tertiary - ANS ✔✔a. Children's
Psychiatric and rehabilitation hospitals, long-term care hospitals, children's hospitals, cancer hospitals,
and critical access hospitals are paid on the basis of reasonable cost, subject to payment limits per
discharge or under separate PPS.
5. Diagnosis-related groups are organized into:
a. Case-mix classifications
b. Geographic practice cost indices
c. Major diagnostic categories
d. Resource-based relative values - ANS ✔✔c. Major diagnostic categories
Diagnosis-related groupings [DRGs] are classified by one of 25 major diagnostic categories [MDCs].
6. In processing a Medicare payment for outpatient radiology examinations, a hospital outpatient
services department would receive payment under which of the following?
a. DRGs
b. HHRGs
c. OASIS
d. OPPS - ANS ✔✔d. OPPS
RADIOLOGY PROCEDURES performed as outpatients are paid under the Medicare prospective payment
system and are identified with a status indicator X for ancillary services.
PRACTICE QUESTIONS & EXAM REVIEW
1. Given the following information, which of the following statements is correct?
191, MCD: 04, Type: MED MS-DRG, Title: Chronic obstructive pulmonary disease w/ CC, Weight: 0.9757,
Discharges: 10, Geometric Mean: 4.1, Arithmetic Mean: 5.0,
192, MCD: 04, Type: COPD w/o CC/MCC, Weight: 0.7254, Discharges: 20, Geometric Mean: 3.3,
Arithmetic Mean: 4.0
193, MCD: 04, Type: MED, Weight: Simple pneumonia & pleurisy w/ MCC, Weight: 1.4327, Discharges:
10, Geometric Mean: 5.4, Arithmetic Mean: 6.7
194, MCD: 04, Type: MED, MS-DRG Title: Simple pneumonia & pleurisy w/ CC, Weight: 1.0056,
Discharges: 20, Geometric Mean: 4.4, Arithmetic Mean: 5.3
195, MCD: 04, Type: MED, MS-DRG Title: Simple pneumonia & pleurisy w/o CC/MCC, Weight: 0.7316,
Discharges: 10, Geometric Mean: 3.5, Arithmetic Mean: 4.1
a. In each MS-DRG the geometric mean is lower than the arithmetic mean.
b. In each MS-DRG the arithmetic mean is lower than the - ANS ✔✔a. In each MS-DRG the geometric
mean is lower than the arithmetic mean.
The GEOMETRIC MEAN LOS is define as the total days of service, excluding any outliers or transfers,
divided by the total number or patients.
2. If another status T procedure were performed, how much would the facility receive for the second
status T procedure?
998323-billing#, V-status indicator, 99285-25-CPT/HCPCS, 0612-APC.
998324-billing#, T-status indicator, 25500-CPT/HCPCS, 0044-APC.
998325-billing#, X-status indicator, 72050-CPT/HCPCS, 0261-APC.
998326-billing#, S-status indicator, 70450-CPT/HCPCS, 0283-APC.
998327-billing#, S-status indicator, 70450-CPT/HCPCS, 0283-APC
a. 0%
b. 50%
c. 75%
d. 100% - ANS ✔✔b. 50%
, Multiple surgical procedures with payment status indicator T performed during the same operative
session are discounted. The highest-weighted procedure is fully reimbursed. All other procedures with
payment status indicator T are reimbursed at 50%.
3. A health information technician is processing payments for hospital outpatient services to be
reimbursed by Medicare for a patient who had two physician visits, underwent radiology examinations,
clinical laboratory tests, and who received take-home surgical dressings. Which of the following services
is reimbursed under the outpatient prospective payment system?
a. Clinical laboratory tests
b. Physician office visits
c. Radiology examinations
d. Take-home surgical dressings - ANS ✔✔c. Radiology examinations
Radiology procedures are identified under the outpatient perspective payment system with a status
indicator X. Status indicator X identifies ancillary services that are separately paid .
4. Which of the following types of hospitals are excluded from the Medicare inpatient prospective
payment system?
a. Children's
b. Rural
c. State supported
d. Tertiary - ANS ✔✔a. Children's
Psychiatric and rehabilitation hospitals, long-term care hospitals, children's hospitals, cancer hospitals,
and critical access hospitals are paid on the basis of reasonable cost, subject to payment limits per
discharge or under separate PPS.
5. Diagnosis-related groups are organized into:
a. Case-mix classifications
b. Geographic practice cost indices
c. Major diagnostic categories
d. Resource-based relative values - ANS ✔✔c. Major diagnostic categories
Diagnosis-related groupings [DRGs] are classified by one of 25 major diagnostic categories [MDCs].
6. In processing a Medicare payment for outpatient radiology examinations, a hospital outpatient
services department would receive payment under which of the following?
a. DRGs
b. HHRGs
c. OASIS
d. OPPS - ANS ✔✔d. OPPS
RADIOLOGY PROCEDURES performed as outpatients are paid under the Medicare prospective payment
system and are identified with a status indicator X for ancillary services.
