CCDS Exam.

CCDS Exam.Blended rate - answerThe base rate plus any add-on reimbursement factors (eg for indirect costs of medical education, capital acquisitions, and disproportionate share of Medicare patients) Case-Mix index (CMI) - answerThe sum of all DRG relative weights divided by the number of Medicare cases. A low CMI may denote DRG assignments that do not adequately reflect the resources used to treat Medicare patients. CMS - answerThe Centers for Medicare and Medicaid, formerly HCFA, the federal agency within the U.S. Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with the state governments to administer Medicaid and the State Children's Health Insurance Program (SCHIP) CC Complication and Comorbidity - answerA condition that, when present, leads to substantially increased hospital resource use, such as intensive monitoring, expensive and technically complex services, and extensive care requiring a greater number of caregivers. Significant acute diseases, acute exacerbations of significant chronic diseases, advanced or end-stage chronic diseases, and chronic diseases associated with extensive debility are representative of CC conditions. Some examples are UTI, acute respiratory insufficiency, and hyponatremia. ICD-9-CM - answerThe International Classification of Diseases, 9th Revision, Clinical Modification. This is the official system of assigning codes to diagnoses and procedures associated with hospital utilization in the United States. IPPS Inpatient prospective payment system - answerA government system for reimbursement of hospital services based on prospectively set rates. MCC Major complication and comorbidity - answerDiagnosis code that reflects the highest level of severity of illness. Some examples are sepsis, acute respiratory failure, acute renal failure, and acute systolic/diastolic heart failure. MS-DRG Medicare Severity diagnosis-related group - answerA payment group for Medicare patients. Patients with similar clinical indicators and costs are linked to a fixed payment based on average costs of patients in the group. Non-OR procedure - answerA procedure performed for the purpose of diagnosing versus definitive treatement. These are generally nonreimbursable, and payment is considered to be bundled into the payment for the medical DRG. OIG Office of Inspector General - answerAssigned to protect the integrity of the HHS programs and the health and welfare of the beneficiaries of these programs. This is accomplished through a nationwide network of audits, investigations, inspections, and other mission-related functions. Outliers - answerExceptional cases for which additional Medicare payment may be available when the cost of care is outside the expected norm for a DRG. PDx Principal diagnosis - answerCondition determined, after careful study, to be chiefly responsible for creating the need for inpatient hospitalization; the foundation for the DRG assignment. Principal procedure - answerA procedure that was performed for definitive treatment (rather than diagnostic or exploratory purposes) or was necessary to treat a complication. The procedure m