chapter 2

Question 1

FINAL calculated dollar amount AFTER ADDING the adjusted rates TO THE BASE RATE

Answer 1

Blended Rate

Question 2

Reimbursement for care provided under the IPPS

Answer 2

Blended Rate

Question 3

Formula for Blended Rate

Answer 3

Final MS DRG (X) Hospital Base Rate + adjusted rates

Question 4

Dollar amount assigned by CMS to individual hospitals

Answer 4

Hospital Base Rate

Question 5

Average of Relative Weights of the DRGS (in a specific patient population) over a set time frame

Answer 5

CMI (Case Mix Index)

Question 6

True or False: DRGS with lower RWs indicate lower SOIs and lower levels of resource consumption than DRGs with higher RWs

Answer 6

True

Question 7

6 Quality Measures utilized by CMS for TOTAL HAC SCORES

Answer 7

Claims Based:
1. PSI 90

Chart Abstracted measure of healthcare - associated infection

2. Central line associated bloodstream infection (CLABSI)
3. Catheter associated UTI (CAUTI)
4. Surgical Site Infection (SSI) for abdominal hysterectomy and colon procedures
5. Methicillin - resistant Staphylococcus aureus (MRSA) bacteremia
6. Clostridium difficile infection

Question 8

POA Code:

W vs U

Answer 8

Clinically undetermined vs Unknown (documentation is insufficient to determine)

Question 9

CMS Recovery Audit Program

Answer 9

To identify and correct improper payments