Domain Revenue Management
Science
- 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 the meaning of the case-mix index? Why is the case-mix index important for a hospital?
- What is the significance of the DNFB report? What does this report include, and what is it used for? Explain how this report may be beneficial 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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