RHIT 2018 - Domain 4 updated to pass

RHIT 2018 - Domain 4. In analyzing the reason for changes in hospital's Medicare case-mix index over time, the analyst should start with which of the following levels of detail? • Account level • MS-DRG level • MDC level • MS-DRG triples, pairs, and singles - correct answer MS-DRG triples, pairs, and singles What does MS-DRG stand for? - correct answer Medicare Severity - Diagnosis Related Group What is the term that means evaluating the appropriateness of the setting for the healthcare service and the level of service? • Coordination of services benefits • Community rating • Outcomes assessment • Utilization review - correct answer Utilization review Which of the following actions would be best to determine whether present on admission (POA) indicators for the conditions selected by CMS are having a negative impact on the hospital's Medicare reimbursement? • Identify all records for a period having these indicators for these conditions and determine whether these conditions are the only secondary diagnoses present on the claim that will lead to higher payment. • Identify all records for a period that have these indicators for these conditions. • Identify all records for a period that have these indicators for these conditions and determine whether or not additional documentation can be submitted to Medicare to increase reimbursement. • Take a random sample of records for a period of records having these indicators for these conditions and extrapolate the negative impact on Medicare reimbursement. - correct answer Identify all records for a period having these indicators for these conditions and determine whether these conditions are the only secondary diagnoses present on the claim that will lead to higher payment A patient is admitted to the hospital with acute lower abdominal pain. The principal diagnosis is acute appendicitis. The patient also has a diagnosis of diabetes. The patient undergoes an appendectomy and subsequently developed two wound infections. In the DRG system, which of the following would be considered a comorbid condition? • Acute appendicitis • Appendectomy • Diabetes • Wound infection - correct answer Diabetes Diagnosis-related groups (DRGs) are organized into: • Case-mix classifications • Geographic practice cost indices • Major diagnostic categories • Resource-based relative values - correct answer Major diagnostic categories NCCI edits prevent improper payments in which of the following cases? • Medical necessity has not been justified by diagnosis. • The count is potentially upcoded.