Revenue Chapter 6

  1. Why does the IPF PPS length of stay adjustment factor grow smaller during the patient encounter?
    The cost of care goes down with each passing day.
  2. List the steps of MS-DRG assignment.
    1) Pre-MDC Assignment (if the encounter has been determined to qualify for this step, then the remaining steps are ignored. 2) Major Diagnostic Category Determination 3) Medical/Surgery Determination 4) Refinement
  3. Why was a severity of illness refinement performed on the DRG system? b) Was it supported by the healthcare community?
    A one size fits all is not always the case. There are always some cases, no matter what is done, that will always be more expensive. These are usually the more severe cases and adjustments need to be made for them. b) Yes, in fact the healthcare community advocated for it.
  4. Describe the medical necessity provision of the IPS PPS.
    In order to keep a patient as an inpatient, each patient must be recertified that they continuing be an inpatient. Outpatient costs are cheaper.
  5. When performing the payment determination for IPS PPS admissions, which step comes first, WI adjustment or application of the patient and facility level adjustments?
    WI adjustments
Card Set
Revenue Chapter 6