CIC CIC Revenue Cycle and Case Mix Management 1

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

CMI is calculated by summing the relative weights of all MS-DRGs for Medicare discharges and dividing by the total number of discharges, reflecting patient complexity.

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

Under IPPS, Medicare pays hospitals a predetermined, fixed amount per discharge based on the MS-DRG assigned to the patient, regardless of actual costs incurred.

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

A drop in CMI after an audit typically indicates that secondary diagnoses were previously being assigned without adequate clinical documentation to support CC or MCC status.

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

Charge capture failures occur when services rendered to patients are not documented or billed appropriately, resulting in lost revenue for the hospital.

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

CMS is responsible for administering the Medicare program, updating MS-DRG groupings and relative weights annually through the IPPS final rule.

CIC - Certified Inpatient Coder Practice Test

CIC - Certified Inpatient Coder Practice Test

CIC CIC Revenue Cycle and Case Mix Management 1