Coding - MS-DRGs and IPPS Questions
& Answers
Hospital Inpatient Prospective Payment System - ANSWERSIPPS is a method of
payment undertaken by CMS to control the cost of inpatient acute care hospital services
to Medicare recipients.
DRGs - ANSWERSpayment rates to hospitals established before services are
rendered.
For fiscal year 2008, Medicare adopted a severity adjusted diagnosis related group
system called? - ANSWERSMedicare Severity DRGs (MS-DRGs)
The goal of of MS-DRG was? - ANSWERSto significantly improve Medicare's ability to
recognize severity of illness in its inpatient hospital payments.
One MS-DRG is assigned to each acute care hospital stay.
MS-DRG is a prospective payment system
The formula for computing the hospital payment for each MS-DRG is: - ANSWERSDRG
relative weight x hospital base rate = hospital payment
Add-on payment, AKA disproportionate share hospital adjustment does what? -
ANSWERSprovides a percentage increase in Medicare payments to hospitals that
qualify under either of two statutory formulas designed to identify hospitals that serve a
disproportionate share of low-income patients.
IME or indirect medical education provides what? - ANSWERSa percentage add-on
payment for each medicare discharge paid under IPPS.
• In addition to the basic payment rate, Medicare provides for an additional payment to
certain hospitals for other factors - ANSWERSo Disproportionate share hospital (DSH)
adjustment
o Indirect medical education (IME) adjustment
o New technologies or medical services approved special add-on payments
o Outlier payment
Some categories of hospitals are paid the higher of a hospital-specific rate based on
their costs in a base year
These hospitals are afforded this special payment protection in order to maintain access
to services by Medicare beneficiaries - ANSWERSo Sole Community Hospitals (SCHs)
o Medicare-dependent Small Rural Hospitals (MDHs)
MS-DRG assignment is based on: - ANSWERSo Diagnoses (principal and secondary)
& Answers
Hospital Inpatient Prospective Payment System - ANSWERSIPPS is a method of
payment undertaken by CMS to control the cost of inpatient acute care hospital services
to Medicare recipients.
DRGs - ANSWERSpayment rates to hospitals established before services are
rendered.
For fiscal year 2008, Medicare adopted a severity adjusted diagnosis related group
system called? - ANSWERSMedicare Severity DRGs (MS-DRGs)
The goal of of MS-DRG was? - ANSWERSto significantly improve Medicare's ability to
recognize severity of illness in its inpatient hospital payments.
One MS-DRG is assigned to each acute care hospital stay.
MS-DRG is a prospective payment system
The formula for computing the hospital payment for each MS-DRG is: - ANSWERSDRG
relative weight x hospital base rate = hospital payment
Add-on payment, AKA disproportionate share hospital adjustment does what? -
ANSWERSprovides a percentage increase in Medicare payments to hospitals that
qualify under either of two statutory formulas designed to identify hospitals that serve a
disproportionate share of low-income patients.
IME or indirect medical education provides what? - ANSWERSa percentage add-on
payment for each medicare discharge paid under IPPS.
• In addition to the basic payment rate, Medicare provides for an additional payment to
certain hospitals for other factors - ANSWERSo Disproportionate share hospital (DSH)
adjustment
o Indirect medical education (IME) adjustment
o New technologies or medical services approved special add-on payments
o Outlier payment
Some categories of hospitals are paid the higher of a hospital-specific rate based on
their costs in a base year
These hospitals are afforded this special payment protection in order to maintain access
to services by Medicare beneficiaries - ANSWERSo Sole Community Hospitals (SCHs)
o Medicare-dependent Small Rural Hospitals (MDHs)
MS-DRG assignment is based on: - ANSWERSo Diagnoses (principal and secondary)
