Coding - MS-DRGs and IPPS Questions + Answers Graded A+

Quality Improvement Organizations (QIOs) perform review services such as: - ️️o Quality of care reviews due to beneficiary complaints, complaints other than from beneficiaries and quality of care reviews referred by CMS or CMS designated entities o Utilization reviews for hospital requested higher weighted diagnosis related group (DRG) payments.o Utilization reviews referred by CMS or CMS designated entities for cases involving issues such as transfers and readmissions o Review of EMTALA cases o Performance of expedited determinations o Provider education on quality of care issues DRGs - ️️payment rates to hospitals established before services are rendered. For fiscal year 2008, Medicare adopted a severity adjusted diagnosis related group system called? - ️️Medicare Severity DRGs (MS-DRGs) The goal of of MS-DRG was? - ️️to 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: - ️️DRG relative weight x hospital base rate = hospital payment Add-on payment, AKA disproportionate share hospital adjustment does what? - ️️provides 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? - ️️a 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 - ️️o 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 yearThese hospitals are afforded this special payment protection in order to maintain access to services by Medicare beneficiaries - ️️o Sole Community Hospitals (SCHs) o Medicare-dependent Small Rural Hospitals (MDHs) MS-DRG assignment is based on: - ️️o Diagnoses (principal and secondary) o Surgical procedures (principal and secondary) o Discharge disposition or status o Presence of major or other complications and comorbidities (MCC or CC) as secondary diagnoses