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

Medicare Part A covers inpatient hospital stays and uses IPPS, which requires ICD-10-CM/PCS coding for payment under DRGs.

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

Diagnosis-Related Group (DRG) grouping classifies inpatient cases into payment categories under IPPS for Medicare reimbursement.

Question 3

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

Accepted Answer

Inpatient admission criteria

Answer

The Two-Midnight Rule establishes that inpatient admission is appropriate when the physician expects the patient to require hospital care spanning at least two midnights.

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

The Official Guidelines for Coding and Reporting are published cooperatively by the AHA, AHIMA, CMS, and NCHS (the four cooperating parties).

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

Medicare Advantage plans are offered by private insurance companies approved by CMS to provide Medicare benefits, often with additional coverage options.

(CDIP) Certified Documentation Improvement Practitioner Practice Test

(CDIP) Certified Documentation Improvement Practitioner Practice Test

CDIP Regulatory and Payer Requirements 2