CCA DRGs, APCs & Risk Adjustment Practice Questions
DRGs, APCs & Risk Adjustment makes up 6 of every 50 questions on a Tigertest CCA practice test. Here are 10 of the 24 questions on it, each with the answer and the reason.
Updated by the Tigertest team. Weighted to the AHIMA CCA Exam Content Outline. Original questions on coding guidelines and concepts; not affiliated with AHIMA.
1. How many MS-DRGs are assigned to one Medicare inpatient stay?
- A.One per day of stay
- B.One
- C.One per procedure
- D.One per diagnosis
Answer: B. The MS-DRG system assigns a single DRG to each inpatient discharge, and that DRG sets the payment for the whole stay.
2. Which element of an inpatient claim determines the Major Diagnostic Category (MDC)?
- A.Admitting diagnosis
- B.First secondary diagnosis
- C.Principal procedure
- D.Principal diagnosis
Answer: D. MDCs are organized by body system, and the principal diagnosis places the case in its MDC. Procedures then help decide the DRG within it.
3. Adding a documented MCC as a secondary diagnosis on an inpatient claim usually:
- A.Raises the DRG relative weight
- B.Replaces the principal diagnosis
- C.Lowers the DRG relative weight
- D.Changes the case's MDC
Answer: A. Many MS-DRGs are split into with MCC, with CC and without CC/MCC levels, and the MCC level carries the highest relative weight. A secondary diagnosis does not change the MDC.
4. A case groups to an MS-DRG with a relative weight of 1.8, and the hospital's base rate is a hypothetical $6,000. What is the DRG payment before adjustments?
- A.$7,800
- B.$108,000
- C.$10,800
- D.$3,333
Answer: C. DRG payment is the relative weight times the base rate: 1.8 x $6,000 = $10,800. Dividing gives $3,333 and adding $1,800 to the base gives $7,800.
5. Four discharges have MS-DRG relative weights of 1.0, 2.0, 0.6 and 1.4. What is the case-mix index?
- A.1.20
- B.1.40
- C.1.25
- D.5.00
Answer: C. The case-mix index is the average relative weight: (1.0 + 2.0 + 0.6 + 1.4) / 4 = 5.0 / 4 = 1.25. The sum is 5.00 and the median is 1.20.
6. Within most MDCs, MS-DRGs are first divided by whether:
- A.An OR procedure was done
- B.The stay was over 3 days
- C.The patient was readmitted
- D.The patient was over 65
Answer: A. Each MDC has a surgical partition for cases with an operating room procedure and a medical partition for cases without one.
7. Under the Medicare 3-day payment window, outpatient diagnostic services an IPPS hospital gives in the 3 days before admission are:
- A.Paid under the physician fee schedule
- B.Billed on a separate outpatient claim
- C.Billed to the patient directly
- D.Bundled into the inpatient claim
Answer: D. Diagnostic services, and related nondiagnostic services, provided by the admitting hospital or an entity it wholly owns in the 3 days before an inpatient admission are reported on the inpatient claim.
8. A Medicare inpatient is transferred to another IPPS acute care hospital before the geometric mean length of stay. The transferring hospital is paid:
- A.Twice the DRG payment
- B.A capped per diem
- C.The full DRG payment
- D.Nothing for the stay
Answer: B. Under the transfer policy, the transferring hospital gets a per diem based on the DRG and its geometric mean length of stay, capped at the full DRG payment. The receiving hospital gets the full DRG.
9. For a DRG covered by the post-acute care transfer policy, which discharge can reduce the payment?
- A.Death during the hospital stay
- B.An early discharge to a SNF
- C.Discharge home with no services
- D.Discharge against medical advice
Answer: B. The post-acute care transfer policy applies when a short stay in a qualifying DRG ends in discharge to a SNF, IRF, LTCH or related home health care. A plain discharge home is paid the full DRG.
10. An IPPS cost outlier payment is added when a case's estimated costs:
- A.Exceed the MDC's average
- B.Include a documented MCC
- C.Fall below the DRG payment
- D.Exceed a fixed-loss threshold
Answer: D. Outlier payments cover part of the cost above the DRG payment plus a fixed-loss threshold, protecting hospitals on extraordinarily costly cases.
Practice all 24 drgs, apcs & risk adjustment questions, and the rest of the 200-question bank, in the free CCA training sets. Questions you miss come back until you have mastered them.
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