Deck 5: Payment Methods and Billing Compliance

Question 1

In inpatient coding, the initials CC mean

A) chief complaint
B) comorbidities and complications
C) cubic centimeters
D) correct coding

Answer 1

B

Question 2

Under the OPPS system, all CPC/HCPCS codes are linked to a ------ code that determines the hospital's payment.

A) APC
B) DRG
C) MCC
D) OCE

Answer 2

A

Question 3

The ------- performs edits on claim data to identify errors and assigns an APC number for each service that is covered under OPPS.

A) MS-Grouper
B) Medicare pricer
C) OCE
D) MCE

Answer 3

C

Question 4

Diagnosis-related groups (DRGs) are categories of inpatients.

Question 5

Edits that represent the procedure and service combinations that cannot be billed together for the same patient on the same day of service because the codes could not have both reasonably been done are known as the

A) CCI mutually exclusive edits
B) medically unlikely edits
C) CCI column 1/column 2 code pair edits
D) non-CCI edits

Question 6

The predetermined rates for inpatient visits under the Medicare Inpatient Prospective Payment System (IPPS) are based on Medicare's analysis of how long people are hospitalized, on average, for similar conditions, and the average cost incurred.

Question 7

Under appropriate circumstances, a -------- may be appended to a component code of a mutually exclusive code to bypass a CCI edit.

A) relative weight
B) status indicator
C) APC code
D) modifier

Question 8

The Inpatient Prospective Payment System is called prospective because it pays for each service based on what the hospital charges rather than on a projected average cost.

Question 9

The Health Care Fraud and Abuse Control Program and the federal False Claims Act are enforced by

A) CMS
B) OIG
C) HIPAA
D) DRA

Question 10

The greater the weight assigned to a DRG, the less resource-intensive it is.

Question 11

Most compliance plans require regular --------; these are performed periodically without a reason to think that a compliance problem exits.

A) HIPAA training sessions
B) internal audits
C) triggered reviews
D) external audits

Question 12

Medicare and hospitals use the MS Grouper software program to assign a patient's DRG.

Question 13

The new Medicare-Severity DRGs (MS-DRGs) differ from CMS DRGs in that they account for geographical differences in the inpatient population.

Question 14

CMS will not assign a higher paying DRG to patients who suffer from hospital-acquired conditions such as pressure ulcers.

Question 15

The Medicare Outpatient Prospective Payment System (OPPS) uses a pricing unit called a CMI (case mix index).

Question 16

Addendum B to the OPPS Final Rule contains a master list of CPT/HCPCS procedure codes with corresponding APC codes and payment rates.

Question 17

An inpatient-only procedure can be performed in an inpatient or outpatient setting; however, the hospital will be reimbursed only if it is performed in an inpatient setting.

Question 18

To bill when a procedure was not done is abuse; to bill when a procedure was not necessary is fraud.

Question 19

Pay-for-performance programs offer financial incentives for voluntary reporting of quality measures such as patient satisfaction and clinical outcomes.

Question 20

The system of analyzing conditions and treatments for similar group of patients used to establish Medicare fees for hospital inpatient services is called the

A) APC system
B) Federal Register
C) Correct Coding Initiative
D) DRG system