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

Under the post-acute care transfer policy, hospitals may receive a reduced, per-diem payment instead of the full DRG payment when patients are transferred to certain post-acute facilities.

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

The HRRP applies financial penalties to hospitals with excess readmissions for specific high-volume conditions including AMI, HF, pneumonia, COPD, hip/knee arthroplasty, and CABG.

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

The chargemaster (CDM) is the master price list containing every billable item and service the hospital offers, serving as the foundation for generating patient bills and claims.

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

Denial management programs track denied claims, pursue appeals for recoverable denials, and analyze denial patterns to implement upstream process improvements that reduce future denials.

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

When a physician updates documentation in response to a query, the coder must revise the codes to reflect the clarified diagnosis and correct any previously submitted claim accordingly.

CIC - Certified Inpatient Coder Practice Test

CIC - Certified Inpatient Coder Practice Test

CIC CIC Revenue Cycle and Case Mix Management 3