Chapter 25 -Coding and Reimbursement
Questions With Correct Answers
The hospital inpatient prospective payment system (IPPS) - ANSWERSIs a method of
payment undertaken by CMS to control the cost of inpatient acute-care hospital services
to Medicare recipients. Title VI of the Social Security Amendments of 1983 established
the prospective payment system (PPS) to provide payment to hospitals for each
Medicare case at a set reimbursement rate, rather than on a fee-for-service or per-day
basis (CMS 2014a). The payment rates to hospitals, then, are established before
services are rendered and are based on diagnosis-related groups (DRGs).
Title VI of the Social Security Amendments of 1983 - ANSWERSestablished the
prospective payment system (PPS) to provide payment to hospitals for each Medicare
case at a set reimbursement rate, rather than on a fee-for-service or per-day basis
(CMS 2014a).
diagnosis-related groups (DRGs). - ANSWERSThe payment rates to hospitals, then,
are established before services are rendered and are based
Medicare Severity Diagnosis-Related Groups (MS-DRGs). - ANSWERSThe goal of the
new MS-DRG system was to significantly improve Medicare's ability to recognize
severity of illness in its inpatient hospital payments. The new system is projected to
increase payments to hospitals for services provided to the sicker patient and decrease
payments for treating less severely ill patients.
3 levels of severity in the MS-DRGs - ANSWERS•MS-DRGs with major complication or
comorbidity (MCC), which reflect the highest level of severity. This level reflects the
sickest patient with the highest level of severity and requires a significant amount of
resources to treat both the principal diagnosis and the additional conditions the patient
has.
•MS-DRG with complication or comorbidity (CC), which is the next level of severity. This
is a mid-level degree of severity based on these secondary diagnoses and requires
additional resources for treating the principal and additional diagnoses.
•MS-DRGs with no complication or comorbidity (non-CC), which do not significantly
affect severity of illness and resource use. This means the patient did not have an
additional condition that required significant additional resources other than what was
needed to treat the condition the patient had
MS-DRGs represent an inpatient classification system designed - ANSWERSdesigned
to categorize patients who are medically related with respect to diagnoses and
treatment and who are statistically similar in their lengths of stay.
Questions With Correct Answers
The hospital inpatient prospective payment system (IPPS) - ANSWERSIs a method of
payment undertaken by CMS to control the cost of inpatient acute-care hospital services
to Medicare recipients. Title VI of the Social Security Amendments of 1983 established
the prospective payment system (PPS) to provide payment to hospitals for each
Medicare case at a set reimbursement rate, rather than on a fee-for-service or per-day
basis (CMS 2014a). The payment rates to hospitals, then, are established before
services are rendered and are based on diagnosis-related groups (DRGs).
Title VI of the Social Security Amendments of 1983 - ANSWERSestablished the
prospective payment system (PPS) to provide payment to hospitals for each Medicare
case at a set reimbursement rate, rather than on a fee-for-service or per-day basis
(CMS 2014a).
diagnosis-related groups (DRGs). - ANSWERSThe payment rates to hospitals, then,
are established before services are rendered and are based
Medicare Severity Diagnosis-Related Groups (MS-DRGs). - ANSWERSThe goal of the
new MS-DRG system was to significantly improve Medicare's ability to recognize
severity of illness in its inpatient hospital payments. The new system is projected to
increase payments to hospitals for services provided to the sicker patient and decrease
payments for treating less severely ill patients.
3 levels of severity in the MS-DRGs - ANSWERS•MS-DRGs with major complication or
comorbidity (MCC), which reflect the highest level of severity. This level reflects the
sickest patient with the highest level of severity and requires a significant amount of
resources to treat both the principal diagnosis and the additional conditions the patient
has.
•MS-DRG with complication or comorbidity (CC), which is the next level of severity. This
is a mid-level degree of severity based on these secondary diagnoses and requires
additional resources for treating the principal and additional diagnoses.
•MS-DRGs with no complication or comorbidity (non-CC), which do not significantly
affect severity of illness and resource use. This means the patient did not have an
additional condition that required significant additional resources other than what was
needed to treat the condition the patient had
MS-DRGs represent an inpatient classification system designed - ANSWERSdesigned
to categorize patients who are medically related with respect to diagnoses and
treatment and who are statistically similar in their lengths of stay.
