Healthcare Reimbursement Chapter 5
Review Questions and Correct Answers
Arithmetic Mean Length of Stay (AMLOS) ✅Sum of all lengths of stay in a set of cases
divided by the number of cases.
Base Payment Rate ✅1) Rate per discharge for operating and capital-related
components for an acute-care hospital. 2) Prospectively set payment rate made for
services that Medicare beneficiaries receive in healthcare settings. The base rate is
adjusted for geographic location, inflation, case mix, and other factors.
Case Mix ✅Set of categories of patients (type and volume) treated by a healthcare
organization and representing the complexity of the organization's caseload.
Case-Mix Index (CMI) ✅Single number that compares the overall complexity of the
healthcare organization's mix of patients with the complexity of the average of all
hospitals. Typically, the CMI is for a specific period and is derived from the sum of all
diagnosis-related group (DRG) weights divided by the number of cases.
CC/MCC Exclusion Lists ✅Set of principal diagnosis codes that is closely related to a
CC or MCC code that takes away the refinement power of the CC or MCC code for an
encounter.
Comorbidity ✅Pre-existing condition that, because of its presence with a specific
diagnosis, causes an increase in length of stay by at least one day in approximately 75
percent of cases.
Complication ✅A condition that arises during the hospital stay that prolongs the length
of stay at least one day in approximately 75 percent of cases.
Complication and Comorbidity (CC) ✅Diagnosis codes that when reported as a
secondary diagnosis have the potential to impact the MS-DRG assignment by
increasing the MS-DRG up one level. CC codes represent an increase in resource
intensity for the admission.
Cost Report ✅Report required from institutional providers on an annual basis for the
Medicare program to make a proper determination of amounts payable to providers
under its provisions in various prospective payment systems.
Cost-of-Living Adjustment (COLA) ✅Alteration that reflects a change in the consumer
price index (CPI), which measures purchasing power between time periods. The CPI is
based on a marker basket of goods and services that a typical consumer buys.
Review Questions and Correct Answers
Arithmetic Mean Length of Stay (AMLOS) ✅Sum of all lengths of stay in a set of cases
divided by the number of cases.
Base Payment Rate ✅1) Rate per discharge for operating and capital-related
components for an acute-care hospital. 2) Prospectively set payment rate made for
services that Medicare beneficiaries receive in healthcare settings. The base rate is
adjusted for geographic location, inflation, case mix, and other factors.
Case Mix ✅Set of categories of patients (type and volume) treated by a healthcare
organization and representing the complexity of the organization's caseload.
Case-Mix Index (CMI) ✅Single number that compares the overall complexity of the
healthcare organization's mix of patients with the complexity of the average of all
hospitals. Typically, the CMI is for a specific period and is derived from the sum of all
diagnosis-related group (DRG) weights divided by the number of cases.
CC/MCC Exclusion Lists ✅Set of principal diagnosis codes that is closely related to a
CC or MCC code that takes away the refinement power of the CC or MCC code for an
encounter.
Comorbidity ✅Pre-existing condition that, because of its presence with a specific
diagnosis, causes an increase in length of stay by at least one day in approximately 75
percent of cases.
Complication ✅A condition that arises during the hospital stay that prolongs the length
of stay at least one day in approximately 75 percent of cases.
Complication and Comorbidity (CC) ✅Diagnosis codes that when reported as a
secondary diagnosis have the potential to impact the MS-DRG assignment by
increasing the MS-DRG up one level. CC codes represent an increase in resource
intensity for the admission.
Cost Report ✅Report required from institutional providers on an annual basis for the
Medicare program to make a proper determination of amounts payable to providers
under its provisions in various prospective payment systems.
Cost-of-Living Adjustment (COLA) ✅Alteration that reflects a change in the consumer
price index (CPI), which measures purchasing power between time periods. The CPI is
based on a marker basket of goods and services that a typical consumer buys.
