Chapter 5 Medicare Hospital Acute
Inpatient Payment System (REVIEW)
Questions & Answers 100% Verified
CMS has articulated its vision for healthcare quality—to optimize health outcomes by
improving clinical quality and transforming the health system (CMS 2014, 3). Based on
this vision, CMS has established three aims: - ANSWERS1. Better care for individuals
2. Better health for the population
3. Lower cost through improvements (CMS 2014, 4)
CMS has established six goals for the CMS Quality Strategy: - ANSWERS1. Make care
safer by reducing harm caused while care is delivered
2. Help patients and their families be involved as partners in their care
3. Promote effective communication and coordination of care
4. Promote effective prevention and treatment of chronic disease
5. Work with communities to help people live healthily
6. Make care affordable
Describe CMS's quality reporting program. - ANSWERSThe quality reporting program
requires healthcare facilities to report data for quality measures. Successful completion
of this VBP program is based on participation, not on the quality of care. Payment rates
are decreased for facilities that do not participate as required by the program.
List the steps of MS-DRG assignment. - ANSWERSPre-MDC assignment; MDC
determination; medical or surgical determination; refinement.
List two examples of refinement questions used in the fourth step of MS-DRG
assignment. - ANSWERSExamples include the following: Is an MCC present? Is a CC
present? Did the patient have a certain disease or condition? Was the procedure
performed for a neoplasm? What was the length of the coma? What is the patient's
sex? What is the patient's discharge status code?
What does the labor-related share of standardized amount represent? - ANSWERSThe
labor portion represents the facilities' relative proportion of wages and salaries,
employee benefits, professional fees, and other labor-intensive services.
What is the formula for the basic IPPS payment calculation? - ANSWERSMS-DRG
relative weight times the facility's fully adjusted hospital-specific base rate.
The Hospital VBP program will measure hospital performance using four domains: -
ANSWERS1. Clinical outcomes
2. Person and community engagement
, 3. Safety
4. Efficiency and cost reduction
What is the basis of the "labor-related share?"
a. Cost-of-living adjustment
b. Facilities' costs related to payrolls, benefits, and professional fees
c. Market-basket index
d. Disproportionate share percentage - ANSWERSb. Facilities' costs related to payrolls,
benefits, and professional fees
In which government publication are the details about the various PPS introduced,
commented on, and finalized?
a. Program transmittals
b. Federal Register
c. Medicare Claims Processing Manual
d. Medicare Learning Network documents - ANSWERSb. Federal Register
In MS-DRGs, the case-mix index is a proxy for what?
a. Risk of mortality
b. Difficulty of treatment
c. Prognosis
d. Consumption of resources - ANSWERSd. Consumption of resources
The MS-DRGs are organized into:
a. Case-mix classifications
b. Geographic practice cost indices
c. Major diagnostic categories
d. Resource-based relative values - ANSWERSc. Major diagnostic categories
The pre-MDC assignment for MS-DRGs is based on:
a. the principal diagnosis
b. admission diagnosis
c. a defined set of ICD-10-PCS procedures
d. the primary procedure - ANSWERSa. the principal diagnosis
The MS-DRG system creates a hospital's case-mix index (types or categories of
patients treated by the hospital) based on the relative weights of the MS-DRG. The case
mix can be figured by multiplying the relative weight of each MS-DRG by the number of
________ within that MS-DRG.
a. Admissions
b. Discharges
c. CCs
d. MCCs - ANSWERSb. Discharges
MS-DRGs are organized into:
a. Case-mix classifications
Inpatient Payment System (REVIEW)
Questions & Answers 100% Verified
CMS has articulated its vision for healthcare quality—to optimize health outcomes by
improving clinical quality and transforming the health system (CMS 2014, 3). Based on
this vision, CMS has established three aims: - ANSWERS1. Better care for individuals
2. Better health for the population
3. Lower cost through improvements (CMS 2014, 4)
CMS has established six goals for the CMS Quality Strategy: - ANSWERS1. Make care
safer by reducing harm caused while care is delivered
2. Help patients and their families be involved as partners in their care
3. Promote effective communication and coordination of care
4. Promote effective prevention and treatment of chronic disease
5. Work with communities to help people live healthily
6. Make care affordable
Describe CMS's quality reporting program. - ANSWERSThe quality reporting program
requires healthcare facilities to report data for quality measures. Successful completion
of this VBP program is based on participation, not on the quality of care. Payment rates
are decreased for facilities that do not participate as required by the program.
List the steps of MS-DRG assignment. - ANSWERSPre-MDC assignment; MDC
determination; medical or surgical determination; refinement.
List two examples of refinement questions used in the fourth step of MS-DRG
assignment. - ANSWERSExamples include the following: Is an MCC present? Is a CC
present? Did the patient have a certain disease or condition? Was the procedure
performed for a neoplasm? What was the length of the coma? What is the patient's
sex? What is the patient's discharge status code?
What does the labor-related share of standardized amount represent? - ANSWERSThe
labor portion represents the facilities' relative proportion of wages and salaries,
employee benefits, professional fees, and other labor-intensive services.
What is the formula for the basic IPPS payment calculation? - ANSWERSMS-DRG
relative weight times the facility's fully adjusted hospital-specific base rate.
The Hospital VBP program will measure hospital performance using four domains: -
ANSWERS1. Clinical outcomes
2. Person and community engagement
, 3. Safety
4. Efficiency and cost reduction
What is the basis of the "labor-related share?"
a. Cost-of-living adjustment
b. Facilities' costs related to payrolls, benefits, and professional fees
c. Market-basket index
d. Disproportionate share percentage - ANSWERSb. Facilities' costs related to payrolls,
benefits, and professional fees
In which government publication are the details about the various PPS introduced,
commented on, and finalized?
a. Program transmittals
b. Federal Register
c. Medicare Claims Processing Manual
d. Medicare Learning Network documents - ANSWERSb. Federal Register
In MS-DRGs, the case-mix index is a proxy for what?
a. Risk of mortality
b. Difficulty of treatment
c. Prognosis
d. Consumption of resources - ANSWERSd. Consumption of resources
The MS-DRGs are organized into:
a. Case-mix classifications
b. Geographic practice cost indices
c. Major diagnostic categories
d. Resource-based relative values - ANSWERSc. Major diagnostic categories
The pre-MDC assignment for MS-DRGs is based on:
a. the principal diagnosis
b. admission diagnosis
c. a defined set of ICD-10-PCS procedures
d. the primary procedure - ANSWERSa. the principal diagnosis
The MS-DRG system creates a hospital's case-mix index (types or categories of
patients treated by the hospital) based on the relative weights of the MS-DRG. The case
mix can be figured by multiplying the relative weight of each MS-DRG by the number of
________ within that MS-DRG.
a. Admissions
b. Discharges
c. CCs
d. MCCs - ANSWERSb. Discharges
MS-DRGs are organized into:
a. Case-mix classifications
