CIC CIC Revenue Cycle and Case Mix Management 3

Question 1

What is the significance of the 'discharge status' code in MS-DRG assignment?

Accepted Answer

It can affect payment, particularly for post-acute care transfers where hospitals may receive a per diem rather than full DRG payment

Answer

It is used only for quality reporting and has no impact on DRG payment

Answer

It determines the patient's insurance eligibility

Answer

It is used exclusively to track readmission rates

Question 2

Under the Medicare Readmissions Reduction Program (HRRP), hospitals may face financial penalties for excessive readmissions related to which conditions?

Accepted Answer

AMI, heart failure, pneumonia, COPD, hip/knee arthroplasty, and CABG, among others

Answer

Only elective surgeries

Answer

Only conditions in patients under age 65

Answer

Any diagnosis if readmitted within 90 days

Question 3

What is the 'chargemaster' (CDM) in a hospital's revenue cycle?

Accepted Answer

A comprehensive list of all services, supplies, and procedures a hospital provides along with their standard charges

Answer

A list of all admitted patients for the day

Answer

A software system for scheduling surgeries

Answer

The hospital's annual budget document

Question 4

What is the purpose of a 'denial management' program in the hospital revenue cycle?

Accepted Answer

To identify, appeal, and resolve denied claims while addressing root causes to prevent future denials

Answer

To prevent all insurance companies from auditing claims

Answer

To delay payment of outstanding hospital vendor invoices

Answer

To manage patient financial assistance applications

Question 5

A CIC is reviewing a claim where the principal diagnosis was changed by the attending physician after a query. What must the coder do?

Accepted Answer

Update the coding to reflect the physician's amended documentation and resubmit the corrected claim if already billed

Answer

Use the original diagnosis to avoid reprocessing the claim

Answer

Ignore the change since it was made after discharge

Answer

File the query response separately without changing the codes

Question 6

What does the term 'revenue integrity' refer to in the context of hospital billing?

Accepted Answer

The process of ensuring that all services are accurately documented, coded, charged, and billed in compliance with regulations

Answer

Ensuring all revenue is deposited into the correct bank account

Answer

A department that manages hospital investments

Answer

The accuracy of payroll processing for hospital employees