AHIMA CCA COMPILATION BUNDLE
STUDY GUIDE 2026 TEST BANK QUESTIONS
AND EXPERT VERIFIED SOLUTIONS
GRADED A+
⩥ The sum of a hospital's total relative DR G weights for a year was
15,192 and the hospital had 10,471 total discharges for the year. Given
this information, what would be the hospital's case-mix index for that
year?
a. 0.689
b. 1.59
c. 1.45 x 100
d. 1.45.
Answer: d. 1.45
The case-mix index is 1.45 for the total case-mix index of the hospital.
An individual MS-DRG case mix ca be figured by multiplying the
relative weight of each MS-DRG by the number of discharges within
that MS-DRG. This provides the total weight for each MS-DRG. The
sum of all total weights [15,192] divided by the sum of total patient
discharges [10,471] equals the case-mix index.
,⩥ 20. In processing a bill under the Medicare outpatient prospective
payment services system [OPPS] in which a patient had three surgical
procedures performed during the same operative session, which of the
following would apply?
a. Bundling of services
b. Outlier adjustment
c. Pass-through payment
d. Discounting of procedures.
Answer: d. Discounting of procedures
DISCOUNTING applies to multiple surgical procedures furnished
during the same operative session. The full rate will be paid to the
surgical procedure with the highest rate and the additional procedures
will be discounted 50% of their APC rate.
⩥ 21. A request for reconsideration of a denied claim for insurance
coverage for healthcare services is called a[n]:
a. Breach
b. Exclusion
c. Appeal
d. Inclusion.
Answer: c. Appeal
, An APPEAL is a request for consideration of denial of coverage for
healthcare services of a claim.
⩥ 22. A denial of a claim is possible for all of the following reasons
EXCEPT:
a. Not meeting medical necessity
b. Billing too many units of a specific service
c. Unbundling
d. Approved precertification.
Answer: d. Approved precertification
PRIOR APPROVAL for a service or procedure is called
PRECERTIFICATION and allows coverage for a specific service.
⩥ 23. Promoting correct coding and control of inappropriate payments is
the basis of NCCI claims processing edits that help identify claims not
meeting medical necessity. The NCCI automated prepayment edits used
by payers is based on all of the following EXCEPT:
a. Coding conventions define in the CPT book
b. National and local policies and coding edits
c. Analysis of standard medical and surgical practice
STUDY GUIDE 2026 TEST BANK QUESTIONS
AND EXPERT VERIFIED SOLUTIONS
GRADED A+
⩥ The sum of a hospital's total relative DR G weights for a year was
15,192 and the hospital had 10,471 total discharges for the year. Given
this information, what would be the hospital's case-mix index for that
year?
a. 0.689
b. 1.59
c. 1.45 x 100
d. 1.45.
Answer: d. 1.45
The case-mix index is 1.45 for the total case-mix index of the hospital.
An individual MS-DRG case mix ca be figured by multiplying the
relative weight of each MS-DRG by the number of discharges within
that MS-DRG. This provides the total weight for each MS-DRG. The
sum of all total weights [15,192] divided by the sum of total patient
discharges [10,471] equals the case-mix index.
,⩥ 20. In processing a bill under the Medicare outpatient prospective
payment services system [OPPS] in which a patient had three surgical
procedures performed during the same operative session, which of the
following would apply?
a. Bundling of services
b. Outlier adjustment
c. Pass-through payment
d. Discounting of procedures.
Answer: d. Discounting of procedures
DISCOUNTING applies to multiple surgical procedures furnished
during the same operative session. The full rate will be paid to the
surgical procedure with the highest rate and the additional procedures
will be discounted 50% of their APC rate.
⩥ 21. A request for reconsideration of a denied claim for insurance
coverage for healthcare services is called a[n]:
a. Breach
b. Exclusion
c. Appeal
d. Inclusion.
Answer: c. Appeal
, An APPEAL is a request for consideration of denial of coverage for
healthcare services of a claim.
⩥ 22. A denial of a claim is possible for all of the following reasons
EXCEPT:
a. Not meeting medical necessity
b. Billing too many units of a specific service
c. Unbundling
d. Approved precertification.
Answer: d. Approved precertification
PRIOR APPROVAL for a service or procedure is called
PRECERTIFICATION and allows coverage for a specific service.
⩥ 23. Promoting correct coding and control of inappropriate payments is
the basis of NCCI claims processing edits that help identify claims not
meeting medical necessity. The NCCI automated prepayment edits used
by payers is based on all of the following EXCEPT:
a. Coding conventions define in the CPT book
b. National and local policies and coding edits
c. Analysis of standard medical and surgical practice
