Explanation:
Coders are responsible for assigning the appropriate diagnosis-related group (DRG) codes based on the patient's medical records and the services provided during their hospital stay. Chargemasters are used to determine the charges associated with each service or item provided by the hospital, including procedures, tests, and medications. Therefore, both coders and chargemasters play crucial roles in selecting the codes for inpatient facility services (IFS).
Explanation:
The APR-DRG (All Patient Refined Diagnosis Related Group) system uses degrees of severity of illness and risk of mortality to determine the DRG. This system is designed to provide a more accurate reflection of the resources required to treat patients by considering both the severity of the illness and the risk of mortality associated with the patient's condition. Other options like MS-DRG (Medicare Severity Diagnosis Related Group), CC/MCC-DRG (Complication or Comorbidity/Major Complication or Comorbidity Diagnosis Related Group), and RUG-IV (Resource Utilization Group Version IV) do not incorporate severity of illness and risk of mortality to the same extent as the APR-DRG system.
Explanation:
In many cases, the average length of stay (LOS) in Long-Term Acute Care Hospitals (LTCHs) exceeds 25 days. These facilities specialize in providing care for patients with serious medical conditions who require extended hospital stays, often longer than those in traditional acute care hospitals.
Explanation:
An Ambulatory Surgical Center (ASC) primarily focuses on outpatient surgical procedures, meaning patients typically arrive for surgery and leave the same day. They are not designed for overnight stays or inpatient care. LTCH (Long-Term Care Hospital), ACF (Acute Care Facility), and CAH (Critical Access Hospital) are all examples of facilities that provide inpatient care, where patients stay for an extended duration, sometimes overnight or longer, to receive treatment or recover from medical conditions.
Explanation:
Inpatient Rehabilitation Facilities (IRFs) typically use the Medicare Severity-Diagnosis Related Group (MS-DRG) payment methodology. This system categorizes patients into groups based on their diagnoses and procedures, with each group having a predetermined payment amount.
Explanation:
*I77.71: This code represents the diagnosis of right internal carotid artery dissection.
*W51.XXXA: This code represents the external cause of injury, which in this case is "struck by a projectile" (softball) in an initial encounter.
*Y93.64: This code represents the activity code for "participation in baseball" at the time of injury.
*Y92.320: This code represents the place of occurrence code for "recreational area" (community baseball field).
Options B, C, and D include different codes that do not accurately represent the scenario described in the question.
Explanation:
Some procedures necessitate inpatient admission even if the patient is discharged on the second day, thus exempting them from the two-midnight rule.
Explanation:
The Outpatient Prospective Payment System (OPPS) reimburses hospitals for outpatient services provided to Medicare beneficiaries. This includes various outpatient procedures, tests, and treatments conducted within a hospital outpatient department.
Explanation:
Medicare Part A primarily covers inpatient hospital care, skilled nursing facility (SNF) care, hospice care, and some home health care. Among the options provided, "Hospice services" are covered under Medicare Part A. This includes palliative care for terminally ill patients with a life expectancy of six months or less.
Explanation:
Medicare covers up to 100 days of care in a skilled nursing facility (SNF) for each benefit period. This coverage includes various services, such as skilled nursing care, physical therapy, and occupational therapy, among others, as long as certain conditions are met.
Explanation:
The inpatient admission certification must be signed by the admitting or attending physician. This ensures that the physician responsible for the patient's care acknowledges and certifies the medical necessity of the inpatient admission. Other personnel, such as hospital administrators, patients' family members, or case managers, do not have the authority to sign the inpatient admission certification.
