AHIMA CCA: Reimbursement Methodologies –
Questions With Objective Solutions
1. Given the following information, which of the following statements is
correct?
191, MCD: 04, Type: MED MS-DRG, Title: Chronic obstructive pulmonary
disease w/ CC, Weight: 0.9757, Discharges: 10, Geometric Mean: 4.1,
Arithmetic Mean: 5.0,
192, MCD: 04, Type: COPD w/o CC/MCC, Weight: 0.7254, Discharges: 20,
Geometric Mean: 3.3, Arithmetic Mean: 4.0
193, MCD: 04, Type: MED, Weight: Simple pneumonia & pleurisy w/ MCC,
Weight: 1.4327, Discharges: 10, Geometric Mean: 5.4, Arithmetic Mean: 6.7
194, MCD: 04, Type: MED, MS-DRG Title: Simple pneumonia & pleurisy w/ CC,
Weight: 1.0056, Discharges: 20, Geometric Mean: 4.4, Arithmetic Mean: 5.3
195, MCD: 04, Type: MED, MS-DRG Title: Simple pneumonia & pleurisy w/o
CC/MCC, Weight: 0.7316, Discharges: 10, Geometric Mean: 3.5, Arithmetic
Mean: 4.1
a. In each MS-DRG the geometric mean is lower than the arithmetic mean.
b. In each MS-DRG the arithmetic mean is lower than the Accurate
Answer:- a. In each MS-DRG the geometric mean is lower than the
arithmetic mean.
The GEOMETRIC MEAN LOS is define as the total days of service, excluding
any outliers or transfers, divided by the total number or patients.
2. If another status T procedure were performed, how much would the facility
receive for the second status T procedure?
998323-billing#, V-status indicator, 99285-25-CPT/HCPCS, 0612-APC.
998324-billing#, T-status indicator, 25500-CPT/HCPCS, 0044-APC.
,998325-billing#, X-status indicator, 72050-CPT/HCPCS, 0261-APC.
998326-billing#, S-status indicator, 70450-CPT/HCPCS, 0283-APC.
998327-billing#, S-status indicator, 70450-CPT/HCPCS, 0283-APC
a. 0%
b. 50%
c. 75%
d. 100% Accurate Answer:- b. 50%
Multiple surgical procedures with payment status indicator T performed
during the same operative session are discounted. The highest-weighted
procedure is fully reimbursed. All other procedures with payment status
indicator T are reimbursed at 50%.
3. A health information technician is processing payments for hospital
outpatient services to be reimbursed by Medicare for a patient who had two
physician visits, underwent radiology examinations, clinical laboratory tests,
and who received take-home surgical dressings. Which of the following
services is reimbursed under the outpatient prospective payment system?
a. Clinical laboratory tests
b. Physician office visits
c. Radiology examinations
d. Take-home surgical dressings Accurate Answer:- c. Radiology
examinations
Radiology procedures are identified under the outpatient perspective
payment system with a status indicator X. Status indicator X identifies
ancillary services that are separately paid .
4. Which of the following types of hospitals are excluded from the Medicare
inpatient prospective payment system?
a. Children's
b. Rural
c. State supported
, d. Tertiary Accurate Answer:- a. Children's
Psychiatric and rehabilitation hospitals, long-term care hospitals, children's
hospitals, cancer hospitals, and critical access hospitals are paid on the basis
of reasonable cost, subject to payment limits per discharge or under separate
PPS.
5. Diagnosis-related groups are organized into:
a. Case-mix classifications
b. Geographic practice cost indices
c. Major diagnostic categories
d. Resource-based relative values Accurate Answer:- c. Major diagnostic
categories
Diagnosis-related groupings [DRGs] are classified by one of 25 major
diagnostic categories [MDCs].
6. In processing a Medicare payment for outpatient radiology examinations, a
hospital outpatient services department would receive payment under which
of the following?
a. DRGs
b. HHRGs
c. OASIS
d. OPPS Accurate Answer:- d. OPPS
RADIOLOGY PROCEDURES performed as outpatients are paid under the
Medicare prospective payment system and are identified with a status
indicator X for ancillary services.
7. Which of the following is NOT reimbursed according to the Medicare
outpatient prospective payment system?
a. CMHC partial hospitalization services
b. Critical access hospitals
c. Hospital outpatient departments
d. Vaccines provided by CORFs Accurate Answer:- b. Critical access
hospitals
Questions With Objective Solutions
1. Given the following information, which of the following statements is
correct?
191, MCD: 04, Type: MED MS-DRG, Title: Chronic obstructive pulmonary
disease w/ CC, Weight: 0.9757, Discharges: 10, Geometric Mean: 4.1,
Arithmetic Mean: 5.0,
192, MCD: 04, Type: COPD w/o CC/MCC, Weight: 0.7254, Discharges: 20,
Geometric Mean: 3.3, Arithmetic Mean: 4.0
193, MCD: 04, Type: MED, Weight: Simple pneumonia & pleurisy w/ MCC,
Weight: 1.4327, Discharges: 10, Geometric Mean: 5.4, Arithmetic Mean: 6.7
194, MCD: 04, Type: MED, MS-DRG Title: Simple pneumonia & pleurisy w/ CC,
Weight: 1.0056, Discharges: 20, Geometric Mean: 4.4, Arithmetic Mean: 5.3
195, MCD: 04, Type: MED, MS-DRG Title: Simple pneumonia & pleurisy w/o
CC/MCC, Weight: 0.7316, Discharges: 10, Geometric Mean: 3.5, Arithmetic
Mean: 4.1
a. In each MS-DRG the geometric mean is lower than the arithmetic mean.
b. In each MS-DRG the arithmetic mean is lower than the Accurate
Answer:- a. In each MS-DRG the geometric mean is lower than the
arithmetic mean.
The GEOMETRIC MEAN LOS is define as the total days of service, excluding
any outliers or transfers, divided by the total number or patients.
2. If another status T procedure were performed, how much would the facility
receive for the second status T procedure?
998323-billing#, V-status indicator, 99285-25-CPT/HCPCS, 0612-APC.
998324-billing#, T-status indicator, 25500-CPT/HCPCS, 0044-APC.
,998325-billing#, X-status indicator, 72050-CPT/HCPCS, 0261-APC.
998326-billing#, S-status indicator, 70450-CPT/HCPCS, 0283-APC.
998327-billing#, S-status indicator, 70450-CPT/HCPCS, 0283-APC
a. 0%
b. 50%
c. 75%
d. 100% Accurate Answer:- b. 50%
Multiple surgical procedures with payment status indicator T performed
during the same operative session are discounted. The highest-weighted
procedure is fully reimbursed. All other procedures with payment status
indicator T are reimbursed at 50%.
3. A health information technician is processing payments for hospital
outpatient services to be reimbursed by Medicare for a patient who had two
physician visits, underwent radiology examinations, clinical laboratory tests,
and who received take-home surgical dressings. Which of the following
services is reimbursed under the outpatient prospective payment system?
a. Clinical laboratory tests
b. Physician office visits
c. Radiology examinations
d. Take-home surgical dressings Accurate Answer:- c. Radiology
examinations
Radiology procedures are identified under the outpatient perspective
payment system with a status indicator X. Status indicator X identifies
ancillary services that are separately paid .
4. Which of the following types of hospitals are excluded from the Medicare
inpatient prospective payment system?
a. Children's
b. Rural
c. State supported
, d. Tertiary Accurate Answer:- a. Children's
Psychiatric and rehabilitation hospitals, long-term care hospitals, children's
hospitals, cancer hospitals, and critical access hospitals are paid on the basis
of reasonable cost, subject to payment limits per discharge or under separate
PPS.
5. Diagnosis-related groups are organized into:
a. Case-mix classifications
b. Geographic practice cost indices
c. Major diagnostic categories
d. Resource-based relative values Accurate Answer:- c. Major diagnostic
categories
Diagnosis-related groupings [DRGs] are classified by one of 25 major
diagnostic categories [MDCs].
6. In processing a Medicare payment for outpatient radiology examinations, a
hospital outpatient services department would receive payment under which
of the following?
a. DRGs
b. HHRGs
c. OASIS
d. OPPS Accurate Answer:- d. OPPS
RADIOLOGY PROCEDURES performed as outpatients are paid under the
Medicare prospective payment system and are identified with a status
indicator X for ancillary services.
7. Which of the following is NOT reimbursed according to the Medicare
outpatient prospective payment system?
a. CMHC partial hospitalization services
b. Critical access hospitals
c. Hospital outpatient departments
d. Vaccines provided by CORFs Accurate Answer:- b. Critical access
hospitals
