CDIP Regulatory and Payer Requirements 2

Question 1

Which federal program requires hospitals to submit claims using ICD-10-CM/PCS codes under the Inpatient Prospective Payment System (IPPS)?

Accepted Answer

Medicare Part A

Answer

Medicaid only

Answer

TRICARE only

Answer

Medicare Part B

Question 2

Under IPPS, what term describes the process of grouping inpatient cases into payment categories based on principal diagnosis, procedures, and other factors?

Accepted Answer

DRG grouping

Answer

APC assignment

Answer

RBRVS calculation

Answer

HCPCS coding

Question 3

CMS's Two-Midnight Rule primarily affects which type of patient status determination?

Accepted Answer

Inpatient admission criteria

Answer

Emergency department classification

Answer

Outpatient observation status

Answer

SNF level of care

Question 4

Which organization publishes the Official Guidelines for Coding and Reporting that CDI professionals must follow for ICD-10-CM/PCS?

Accepted Answer

AHA and CMS jointly

Answer

AHIMA alone

Answer

AMA only

Answer

The Joint Commission

Question 5

A Medicare Advantage plan (Part C) differs from traditional Medicare primarily in that it:

Accepted Answer

Is administered by private insurers approved by CMS

Answer

Uses only CPT codes for payment

Answer

Covers only outpatient services

Answer

Does not require ICD-10 coding

Question 6

Under the False Claims Act, what is the minimum per-claim civil penalty a hospital faces for knowingly submitting a false Medicare claim?

Accepted Answer

$13,000 (adjusted for inflation)

Answer

$500

Answer

$5,000

Answer

$100,000

Question 7

Which type of Medicare review contractor conducts post-payment reviews of inpatient claims to identify improper payments and potential fraud?

Accepted Answer

RAC (Recovery Audit Contractor)

Answer

MAC (Medicare Administrative Contractor)

Answer

ZPIC (Zone Program Integrity Contractor)

Answer

QIO (Quality Improvement Organization)