CIC CIC Revenue Cycle and Case Mix Management

Question 1

What is Case Mix Index (CMI) and how is it calculated for a hospital?

Accepted Answer

The sum of all MS-DRG relative weights divided by the total number of Medicare discharges

Answer

Total charges divided by total admissions

Answer

The average length of stay across all patients

Answer

Total reimbursement received divided by total beds

Question 2

Under the Medicare Inpatient Prospective Payment System (IPPS), how are hospitals primarily paid for inpatient services?

Accepted Answer

A flat per-discharge amount based on the assigned MS-DRG

Answer

Per diem (daily rate) based on actual services

Answer

Fee-for-service for each procedure performed

Answer

Based on the total itemized bill submitted

Question 3

A hospital's CMI drops significantly after a coding audit. What is the most likely explanation?

Accepted Answer

Secondary diagnoses (CCs/MCCs) were previously being overcoded or captured without sufficient documentation

Answer

The hospital treated fewer patients

Answer

The hospital reduced its number of surgeons

Answer

Insurance payer mix changed to more Medicare

Question 4

What is a 'charge capture' problem in the revenue cycle?

Accepted Answer

When services provided are not billed due to missing or incorrect documentation

Answer

When patients are charged twice for the same service

Answer

When insurance companies deny all claims

Answer

When hospital chargemasters are updated annually

Question 5

Which federal agency oversees the Medicare IPPS and sets MS-DRG relative weights annually?

Accepted Answer

Centers for Medicare & Medicaid Services (CMS)

Answer

The Joint Commission (TJC)

Answer

American Health Information Management Association (AHIMA)

Answer

Office of the Inspector General (OIG)

Question 6

What is the purpose of the Medicare Code Editor (MCE) in the claims processing workflow?

Accepted Answer

To identify invalid, inconsistent, or questionable ICD-10-CM/PCS code combinations on inpatient claims

Answer

To process physician fee schedule claims

Answer

To approve all inpatient admissions

Answer

To calculate hospital length of stay benchmarks