CCS Exam Prep with Verified Answers 100% Correct!!
IPPS - -inpatient prospective payment system
Page | 1
OPPS - -Outpatient Prospective Payment System
fee-for-service (FFS) - -a written fee schedule for each treatment and/or service
provided
Diagnosis-related groups (DRGs) - -an episodic care payment system to hospitals for
inpatient services based on standards of care for a specific diagnoses grouped by their
similar usage of resources for procedures, service, and treatments
MS-DRG - -Medicare Severity Diagnosis Related Group
Case-Mix Index (CMI) - -the average relative weight of all patients treated at a
specific facility or by a specific physician to measure clinical severity or resource utilization
Ambulatory patient classifications (APC) - -a prospective payment system for
hospital outpatient services provided to Medicare and Medicaid beneficiaries
Major complications and co-morbidities (MCC) - -complications of an existing
condition and/or co-morbidities (other unrelated conditions that require care during the
stay) that make caring for the patient more intense and complex
Complications and co-morbidities (CC) - -unexpected conditions that develop as a
result of a service or hospital stay
, Hospital-aquired conditions (HAC) - -a condition or illness that the patient
contracted while admitted at a facility
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Non-PAR limiting charge - -for a non-participating physician who does not accept
assignment, the limiting charge is 15% over the non-PAR allowed amount
National Correct Coding Initiative (NCCI) edits - -reinforce accurate and proper
coding and prevent reimbursement of inaccurate amounts due to non-compliance coding
methods in Part B claims (physician and outpatient services)
Medically unlikely edits (MUE) - -codes (services) reported with incorrect units of
service
Remittance advice (RA) - -notification identifying details about a payment from the
third-party payer to a provider
UB-04 - -the paper claim form used by hospitals
CMS-1500 - -the paper claim form used by outpatient facilities and physicians
premium - -money paid by an individual to purchase health care coverage
deductible - -the amount the individual must pay out-of-pocket before the policy
benefits apply
, co-payment - -a set amount paid by the individual at each health care encounter
co-insurance - -an amount paid by the individual; based on a percentage of the total
Page | 3 allowed amount for the encounter, service, or treatment
the residual condition is coded first, followed by cause - -When coding a residual
condition where there is no applicable late effect code, one should code
Sequela - -A ____ is the residual effect (condition produced) after the acute phase of
an illness or injury has terminated.
condition or nature of the sequela first. sequela code is sequenced second - -Coding
of sequela generally requires two codes sequenced in the following order:
MDS (minimum data set) - -The federally mandated resident assessment instrument
used in long-term care facilities consists of three basic components, including the new
care area assessment, utilization guidelines, and the
subjective symptoms that the patient may have forgotten to mention or that may have
seemed unimportant. - -When asked to explain how "review of systems" differs from
"physical exam," you explain that the review of systems is used to document
Review of Systems (ROS) - -the relevant signs or symptoms the patient is
experiencing at the time of the encounter
Physical Exam (PE) - -something the provider observed in the assessment
IPPS - -inpatient prospective payment system
Page | 1
OPPS - -Outpatient Prospective Payment System
fee-for-service (FFS) - -a written fee schedule for each treatment and/or service
provided
Diagnosis-related groups (DRGs) - -an episodic care payment system to hospitals for
inpatient services based on standards of care for a specific diagnoses grouped by their
similar usage of resources for procedures, service, and treatments
MS-DRG - -Medicare Severity Diagnosis Related Group
Case-Mix Index (CMI) - -the average relative weight of all patients treated at a
specific facility or by a specific physician to measure clinical severity or resource utilization
Ambulatory patient classifications (APC) - -a prospective payment system for
hospital outpatient services provided to Medicare and Medicaid beneficiaries
Major complications and co-morbidities (MCC) - -complications of an existing
condition and/or co-morbidities (other unrelated conditions that require care during the
stay) that make caring for the patient more intense and complex
Complications and co-morbidities (CC) - -unexpected conditions that develop as a
result of a service or hospital stay
, Hospital-aquired conditions (HAC) - -a condition or illness that the patient
contracted while admitted at a facility
Page | 2
Non-PAR limiting charge - -for a non-participating physician who does not accept
assignment, the limiting charge is 15% over the non-PAR allowed amount
National Correct Coding Initiative (NCCI) edits - -reinforce accurate and proper
coding and prevent reimbursement of inaccurate amounts due to non-compliance coding
methods in Part B claims (physician and outpatient services)
Medically unlikely edits (MUE) - -codes (services) reported with incorrect units of
service
Remittance advice (RA) - -notification identifying details about a payment from the
third-party payer to a provider
UB-04 - -the paper claim form used by hospitals
CMS-1500 - -the paper claim form used by outpatient facilities and physicians
premium - -money paid by an individual to purchase health care coverage
deductible - -the amount the individual must pay out-of-pocket before the policy
benefits apply
, co-payment - -a set amount paid by the individual at each health care encounter
co-insurance - -an amount paid by the individual; based on a percentage of the total
Page | 3 allowed amount for the encounter, service, or treatment
the residual condition is coded first, followed by cause - -When coding a residual
condition where there is no applicable late effect code, one should code
Sequela - -A ____ is the residual effect (condition produced) after the acute phase of
an illness or injury has terminated.
condition or nature of the sequela first. sequela code is sequenced second - -Coding
of sequela generally requires two codes sequenced in the following order:
MDS (minimum data set) - -The federally mandated resident assessment instrument
used in long-term care facilities consists of three basic components, including the new
care area assessment, utilization guidelines, and the
subjective symptoms that the patient may have forgotten to mention or that may have
seemed unimportant. - -When asked to explain how "review of systems" differs from
"physical exam," you explain that the review of systems is used to document
Review of Systems (ROS) - -the relevant signs or symptoms the patient is
experiencing at the time of the encounter
Physical Exam (PE) - -something the provider observed in the assessment
