Domain Revenue Management
Question Description
Analyze the information given in the table below.
MS-DRG MDC Type MS-DRG Title Weight Discharges Geometric Mean Arithmetic Mean
191 04 MED Chronic Obstructive Pulmonary Disease w CC 0.9184 100 3.3 4.0
192 04 MED Chronic Obstructive Pulmonary Disease w/o CC/MCC 0.7234 180 2.7 3.2
193 04 MED Simple pneumonia & pleurisy w MCC 1.3860 110 4.6 5.7
194 04 MED Simple pneumonia & pleurisy w CC 0.9469 200 3.6 4.3
195 04 MED Simple pneumonia & pleurisy w/o CC/MCC 0.7028 80 2.8 3.3
Based on the data given, determine the case-mix index. What is themeaning of the case-mix index? Why is the case-mix index important for ahospital?
What is the significance of the DNFB report? What does this reportinclude, and what is it used for? Explain how this report may bebeneficial to the coding department.
Choose one of the topics below to talk about:
Fee schedules- how often are they updated
Fee-for-service payment method
Medicare Inpatient Prospective System Exclusions
OPPS Bundling
Queries- Leading/Non-leading, when are they used
Upcoding/undercoding/bundling
Outpatient Code Editors
Present on Admission
When the code books are updated (CPT, ICD-10-CM, ICD-10-PCS)
Hospital acquired conditions definition
Definitions of adjudication, reimbursement
Definitions of medical necessity, eligibility, deductible, coninsurance, copyament
Understand the revenue cycle (what is it, what is included)
Know the difference between first party, second party, and third party payers
Know about the marketplace offered through ACA
Know the difference between a prospective, retrospective review
Know what case management is and what they do
Know the definition of case mix index and how to calculate
Know what an RBRVS is
Discuss what the DNFB report is, what is on it, and why it matters
Know the basics of APCs and DRGs
Know the basics of the IPPS and OPPS (when did they get enacted)
Some basic coding and code formats
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