CIC DRG Assignment and Reimbursement

Question 1

What is the primary purpose of MS-DRG (Medicare Severity Diagnosis Related Group) assignment?

Accepted Answer

Classifying inpatient stays into groups for prospective payment reimbursement

Answer

MS-DRGs classify inpatient hospital stays into clinically meaningful groups that determine the prospective payment amount from Medicare.

Question 2

How do complications and comorbidities (CC/MCC) affect DRG assignment?

Accepted Answer

They can increase the DRG weight, resulting in higher reimbursement to reflect greater resource use

Answer

CCs and MCCs increase the DRG severity level and weight, resulting in higher reimbursement that reflects the additional resources needed to treat more complex patients.

Question 3

What is the role of the principal diagnosis in DRG assignment?

Accepted Answer

It is the condition established after study to be chiefly responsible for occasioning the admission

Answer

The principal diagnosis, defined as the condition chiefly responsible for the admission, is the primary driver of DRG assignment and must be determined after study.

Question 4

What is a grouper in the context of inpatient coding?

Accepted Answer

Software that assigns the appropriate DRG based on coded diagnoses, procedures, and patient demographics

Answer

A DRG grouper is software that processes coded data including diagnoses, procedures, age, sex, and discharge status to assign the appropriate DRG.

Question 5

What is a DRG weight and how does it affect hospital payment?

Accepted Answer

A relative value assigned to each DRG that is multiplied by the hospital's base rate to determine payment

Answer

Each DRG has a relative weight reflecting average resource consumption; this weight is multiplied by the hospital's base rate to calculate the prospective payment.

CIC - Certified Inpatient Coder Practice Test

CIC - Certified Inpatient Coder Practice Test

CIC DRG Assignment and Reimbursement