The fourth step is
A. cases are differentiated based on the presence or absence of complications/ comorbidites (CCs) or major complications comorbidites (MCCS).
B. cases are divided into either a surgical partition or a medical partition.
C. the principal diagnosis determines the MDC assignment.
D. diagnoses and procedures are coded using ICD-9-CM.
The third step is
A. cases are differentiated based on the presence or absence of complications/ comorbidites (CCs) or major complications comorbidites (MCCS).
B. cases are divided into either a surgical partition or a medical partition.
C. the principal diagnosis determines the MDC assignment.
D. diagnoses and procedures are coded using ICD-9-CM.
The second step is
A. cases are differentiated based on the presence or absence of complications/ comorbidites (CCs) or major complications comorbidites (MCCS).
B. cases are divided into either a surgical partition or a medical partition.
C. the principal diagnosis determines the MDC assignment.
D. diagnoses and procedures are coded using ICD-9-CM.
The first step is
A. cases are differentiated based on the presence or absence of complications/comorbidites (CCs) or major complications/comorbidites (MCCs).
B. cases are divided into either a surgical partition or a medical partition.
C. the principal diagnosis determines the MDC assignment.
D. diagnoses and procedures are coded using ICD-9-CM.
This means that the service or procedure is reasonable and necessary for the diagnosis or treatment of illness or injury consistent with generally accepted standards of care.
A. peer review
B. optimization
C. benchmarking
D. medical necessity
These are assigned to every HCPCS/CPT code under the Medicare hospital outpatient prospective payment system to identify how the service or procedure described by the code would be paid.
A. geographic practice cost indices
B. major diagnostic categories
C. minimum data set
D. payment status indicator
Home health agencies are reimbursed on a prospective payment system (PPS) for Medicare patients. This PPS is called
A. home health resource groups (HHRGs).
B. case-mix groups (CMGs).
C. diagnosis-related groups (DRGs).
D. resource utilization groups (RUGs).
All of the following elements are found in the charge description master, EXCEPT for
A. ICD-9-CM code.
B. charge.
C. HCPCS/CPT code.
D. narrative description.
Based on this patient volume, the MS-DRG which brings in the highest total profit to the hospital is
A. 470.
B. 247.
C. 392.
D. It cannot be determined from this information.
Which of the listed MS-DRGs has the highest CMS relative weight?
A. 247
B. 470
C. 871
D. 293
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