CIC Revenue Cycle and Case Mix Management Flashcards
6 cards from real CIC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 CIC Revenue Cycle and Case Mix Management flashcards as text
What is the significance of the 'discharge status' code in MS-DRG assignment?
Answer: It can affect payment, particularly for post-acute care transfers where hospitals may receive a per diem rather than full DRG payment
Under the post-acute care transfer policy, hospitals may receive a reduced, per-diem payment instead of the full DRG payment when patients are transferred to certain post-acute facilities.
Under the Medicare Readmissions Reduction Program (HRRP), hospitals may face financial penalties for excessive readmissions related to which conditions?
Answer: AMI, heart failure, pneumonia, COPD, hip/knee arthroplasty, and CABG, among others
The HRRP applies financial penalties to hospitals with excess readmissions for specific high-volume conditions including AMI, HF, pneumonia, COPD, hip/knee arthroplasty, and CABG.
What is the 'chargemaster' (CDM) in a hospital's revenue cycle?
Answer: A comprehensive list of all services, supplies, and procedures a hospital provides along with their standard charges
The chargemaster (CDM) is the master price list containing every billable item and service the hospital offers, serving as the foundation for generating patient bills and claims.
What is the purpose of a 'denial management' program in the hospital revenue cycle?
Answer: To identify, appeal, and resolve denied claims while addressing root causes to prevent future denials
Denial management programs track denied claims, pursue appeals for recoverable denials, and analyze denial patterns to implement upstream process improvements that reduce future denials.
A CIC is reviewing a claim where the principal diagnosis was changed by the attending physician after a query. What must the coder do?
Answer: Update the coding to reflect the physician's amended documentation and resubmit the corrected claim if already billed
When a physician updates documentation in response to a query, the coder must revise the codes to reflect the clarified diagnosis and correct any previously submitted claim accordingly.
What does the term 'revenue integrity' refer to in the context of hospital billing?
Answer: The process of ensuring that all services are accurately documented, coded, charged, and billed in compliance with regulations
Revenue integrity encompasses the end-to-end accuracy and compliance of the revenue cycle, from documentation and coding through charging and billing, minimizing both underpayments and compliance risk.