AHIMA Revenue Cycle Management 3

Question 1

Under the MS-DRG system, what factors most directly determine a patient's DRG assignment?

Accepted Answer

The principal diagnosis, secondary diagnoses (CCs/MCCs), and major procedures

Answer

MS-DRG assignment is driven primarily by the principal diagnosis, the presence of complications or comorbidities (CCs/MCCs), and major procedures performed.

Question 2

Which reimbursement methodology does Medicare use for outpatient hospital services under OPPS?

Accepted Answer

Ambulatory Payment Classifications (APCs)

Answer

Medicare reimburses outpatient hospital services via Ambulatory Payment Classifications (APCs) under the Outpatient Prospective Payment System (OPPS).

Question 3

What does the term 'upcoding' mean in medical billing?

Accepted Answer

Assigning a higher-level code than documented to increase reimbursement

Answer

Upcoding is assigning a billing code for a more expensive or complex service than what was actually documented or performed, constituting fraud.

Question 4

Which of the following is typically found in a Charge Description Master (CDM)?

Accepted Answer

Revenue codes, CPT/HCPCS codes, descriptions, and standard charges

Answer

The CDM (chargemaster) is the facility's master price list containing revenue codes, CPT/HCPCS codes, service descriptions, and standard charges for all billable items.

Question 5

HCPCS Level II codes are primarily used to report:

Accepted Answer

Durable medical equipment, supplies, and non-physician services

Answer

HCPCS Level II alpha-numeric codes cover items such as DME, ambulance services, orthotics, prosthetics, and drugs not classified within CPT.

(AHIMA) American Health Information Management Association Practice Test

(AHIMA) American Health Information Management Association Practice Test

AHIMA Revenue Cycle Management 3