Domain 4

Question 1

In analyzing the reason for changes in a hospitals Medicare case mix index over time, the analyst should start with which of the following levels of detail?
A. Account level
B. MS-DRG level
C. MDC level
D. MS-DRG triples, pairs and singles

Answer 1

D.

Question 2

301. What is the term that means evaluating the appropriateness of the setting for the healthcare service and the level of service?
A. Coordination of service benefits
B. Community rating 
C. Outcomes assessment
D. utilization review

Answer 2

D.

Question 3

302. Which of the following actions would be best to determine whether present of admission (POA) indicators for the conditions selected by CMS are having on the hospitals Medicare reimbursement?

Answer 3

A. Identify all records for a period having these indicators for these conditions and determine whether these conditions are the only secondary diagnosis present on the claim that will lead to higher payment