CCDS questions with complete solutions graded A+

CCDS questions with complete solutions graded A+Blended rate The base rate plus any add-on reimbursement factors (eg for indirect costs of medical education, capital acquisitions, and disproportionate share of Medicare patients) Case-Mix index (CMI) The sum of all DRG relative weights divided by the number of Medicare cases. A low CMI may denote DRG assignments that do not adequately reflect the resources used to treat Medicare patients. 00:25 01:20 CMS The Centers for Medicare and Medicaid, formerly HCFA, the federal agency within the U.S. Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with the state governments to administer Medicaid and the State Children's Health Insurance Program (SCHIP) CC Complication and Comorbidity A condition that, when present, leads to substantially increased hospital resource use, such as intensive monitoring, expensive and technically complex services, and extensive care requiring a greater number of caregivers. Significant acute diseases, acute exacerbations of significant chronic diseases, advanced or end-stage chronic diseases, and chronic diseases associated with extensive debility are representative of CC conditions. Some examples are UTI, acute respiratory insufficiency, and hyponatremia. ICD-9-CM The International Classification of Diseases, 9th Revision, Clinical Modification. This is the official system of assigning codes to diagnoses and procedures associated with hospital utilization in the United States. IPPS Inpatient prospective payment system A government system for reimbursement of hospital services based on prospectively set rates. MCC Major complication and comorbidity Diagnosis code that reflects the highest level of severity of illness. Some examples are sepsis, acute respiratory failure, acute renal failure, and acute systolic/diastolic heart failure. MS-DRG Medicare Severity diagnosis-related group A payment group for Medicare patients. Patients with similar clinical indicators and costs are linked to a fixed payment based on average costs of patients in the group. Non-OR procedure A procedure performed for the purpose of diagnosing versus definitive treatement. These are generally nonreimbursable, and payment is considered to be bundled into the payment for the medical DRG. OIG Office of Inspector General Assigned to protect the integrity of the HHS programs and the health and welfare of the beneficiaries of these programs. This is accomplished through a nationwide network of audits, investigations, inspections, and other mission-related functions.