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a preexisting condition that is present on admission and may lead to increased resource used
The condition that after study is established as chiefly responsible for occasioning the admission of the patient to the hospital is called
calculate the case mix for the following patients using the wieghts from appendix E
0.9077 case mix index
condition that arises during a patients hospitalization which may lead to increased resource use
supporting documentation in the health record, or with disregard for coding conventions, guidelines, and uhdds definitions
condition established after study as chiefly responsivle for occasioning admission of the patient to the hospital for care
process of striving to obtain optimal reimbursement or the highest possible payment to which the facility is legally entitled, on the basis of documentation in the health record
listing of the services, procedures, drugs and supplies that can be applied to a patients bill
local coverage determinations
local policy that may include certain time frames for testing, that a peatient be a certain age, and that a particular diagnosis or condition is present to be considered medically necessary
criteria or guidelines for what is determined to be reasonable and necessary for a particular medical service
ancillary departments such as radiology, laboratory, emergency room will have a specific hospital department number
national coverage determinations
national policy that may include certain time frames for testing that a patient be a certain age than that a particular diagnosis or condition is present ot be considered medically necessary
charge description number
a number that designates a particular service or procedure and is used to generate a charge on a patient bill
a four digit code that is utilized on the ub-04 to indicate a particular type of service
other factors that may play a role in msdrg assignment besides principal and secondary diagnoses and procedures include
sex, discharge disposition, and birthweight for neonates
an electronic report sent to hospitals taht contains hospital-specific information for specific msdrg target areas is known as
an org that acts under the direction of cms and is contracted to minitor the quality of health care and to make sure that medicare pays only for services that are reasonable and necessary is
the purpose of a cdip is to improve clinical docs in the patient record;should improve case mix index and same time for coders and physicians by reducing the number of queries T/f
During the month of July, the following Medicare patients were discharged from Hospital B. Using Appendix E (starting on page 761 of textbook), calculate the case mix for the following:
2 patients MS-DRG 100
2 patients MS-DRG 460
1 patient MS-DRG 066
3 patients MS-DRG 740
2 patients MS-DRG 418
The CMI for July is:
items that are related to retrospective payment system
based on charges, based on drg so payment is determined before the care is rendered, incentive to decrease complications, need to provide quality care in an efficient manner to maintain bottom line
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