Medicare acute care PPS
PPS - answer Prospective Payment System
2 Types of medical coding: - answer outpatient and inpatient
The illness or trauma that brought the patient to the hospital. - answer Admitting
Diagnosis
A method that groups patients based on a specific set of characteristics (such as
principal diagnoses and procedures and resources being used - answer Case Mix
CMI - answer Case Mix Index
Additional illnesses present at the time of the patient's admission to the hospital, often
complicating treatment or prolonging the patient's stay in the hospital - answer
Comorbidities
DRGs - answer Diagnosis Related Groups
An inpatient reimbursement and classification system based on a formula that uses the
patient's age, gender, admitting diagnosis, ICD-10-CM diagnosis, procedure codes, and
discharge status. - answerDiagnosis Related Groups (DRGs)
AP-DRGs - answerall patient diagnosis-related groups
Classification system created to classify non-Medicare patient populations - answerAll
Patient Diagnosis-Related Groups (AP-DRGs)
MS-DRGs - answerMedicare Severity Diagnosis Related Groups
An update of the DRG system implemented in 2007 by CMS. - answerMedicare
Severity Diagnosis Related Groups (MS-DRGs)
A computer software program used by a coder to assign the appropriate DRG to a
group of diagnosis and procedure codes - answerDRG/MS-DRG Grouper
MCC - answerMajor Complicating Conditions
A new severity level under the new MS-DRG classification system - answerMajor
Complicating Conditions (MCC)
PPS - answer Prospective Payment System
2 Types of medical coding: - answer outpatient and inpatient
The illness or trauma that brought the patient to the hospital. - answer Admitting
Diagnosis
A method that groups patients based on a specific set of characteristics (such as
principal diagnoses and procedures and resources being used - answer Case Mix
CMI - answer Case Mix Index
Additional illnesses present at the time of the patient's admission to the hospital, often
complicating treatment or prolonging the patient's stay in the hospital - answer
Comorbidities
DRGs - answer Diagnosis Related Groups
An inpatient reimbursement and classification system based on a formula that uses the
patient's age, gender, admitting diagnosis, ICD-10-CM diagnosis, procedure codes, and
discharge status. - answerDiagnosis Related Groups (DRGs)
AP-DRGs - answerall patient diagnosis-related groups
Classification system created to classify non-Medicare patient populations - answerAll
Patient Diagnosis-Related Groups (AP-DRGs)
MS-DRGs - answerMedicare Severity Diagnosis Related Groups
An update of the DRG system implemented in 2007 by CMS. - answerMedicare
Severity Diagnosis Related Groups (MS-DRGs)
A computer software program used by a coder to assign the appropriate DRG to a
group of diagnosis and procedure codes - answerDRG/MS-DRG Grouper
MCC - answerMajor Complicating Conditions
A new severity level under the new MS-DRG classification system - answerMajor
Complicating Conditions (MCC)
