HIT 230 MODULE 6-10 | 105 QUESTIONS AND ANSWERS |
2026 UPDATE | WITH COMPLETE SOLUTION
Which of the following concepts is a guiding principle for prospective payment?
Answer - Payment rates are established in advance of the healthcare delivery
and are fixed for the fiscal period to which they apply.
[There are 4 guiding principles of prospective payment: See pg 115
Payment rates are to be established in advance and fixed for the fiscal period to
which they apply
Payment rates are not automatically determined by the hospital's past or
current actual cost.
Prospective payment rates are considered to be payment in full.
The hospital retains the profit or suffers a loss resulting from the difference
between the payment rate and the hospital's cost, creating an incentive for
cost control.]
Which piece of legislation called for the first hospital inpatient prospective
payment system? This piece of legislation also allowed some hospital setting to
retain their cost-based payment systems. Answer - Tax Equity and Fiscal
Responsibility Act (TEFRA)
[The TEFRA of 1982 mandated extensive changes to the Medicare program,
and called for the implementation of a PPS for hospital inpatients.]
, What is the average of the sum of the relative weights of all patients treated
during a specified time period? Answer - Case mix index
[The cas mix indes is a weighted average of the sum of the relative weights of
all patients treated during a specified time period.]
Which is the correct formula for IPF wage index adjustment? Answer - (federal
payment rate * labor portion * WI) + (federal payment rate * non-labor
portion)
What is the basis of the "labor-related share"? Answer - Facilities' costs related
to payrolls, benefits, and professional fees
In which government publication are the details about the various PPS
introduced, commented on and finalized? Answer - Federal Register
The MS-DRG payment includes reimbursement for all of the following inpatient
services except: Answer - Physician hospital visit
Mr. Brown was admitted to the hospital with severe chest pains. During his
encounter he underwent a coronary artery bypass procedure (CABG) due to
coronary artery disease (CAD). What is the first step in determining the MS-
DRG assignment for this encounter? Answer - Determine if the coronary artery
bypass procedure is one of the Pre-MDC procedures
[See pg 117- Step 1: Pre-MDC assignment.]
What is the general term for software that assigns inpatient diagnosis related
groups? Answer - Grouper
[computer programs that assign patients to case-mix groups are generically
called groupers]
2026 UPDATE | WITH COMPLETE SOLUTION
Which of the following concepts is a guiding principle for prospective payment?
Answer - Payment rates are established in advance of the healthcare delivery
and are fixed for the fiscal period to which they apply.
[There are 4 guiding principles of prospective payment: See pg 115
Payment rates are to be established in advance and fixed for the fiscal period to
which they apply
Payment rates are not automatically determined by the hospital's past or
current actual cost.
Prospective payment rates are considered to be payment in full.
The hospital retains the profit or suffers a loss resulting from the difference
between the payment rate and the hospital's cost, creating an incentive for
cost control.]
Which piece of legislation called for the first hospital inpatient prospective
payment system? This piece of legislation also allowed some hospital setting to
retain their cost-based payment systems. Answer - Tax Equity and Fiscal
Responsibility Act (TEFRA)
[The TEFRA of 1982 mandated extensive changes to the Medicare program,
and called for the implementation of a PPS for hospital inpatients.]
, What is the average of the sum of the relative weights of all patients treated
during a specified time period? Answer - Case mix index
[The cas mix indes is a weighted average of the sum of the relative weights of
all patients treated during a specified time period.]
Which is the correct formula for IPF wage index adjustment? Answer - (federal
payment rate * labor portion * WI) + (federal payment rate * non-labor
portion)
What is the basis of the "labor-related share"? Answer - Facilities' costs related
to payrolls, benefits, and professional fees
In which government publication are the details about the various PPS
introduced, commented on and finalized? Answer - Federal Register
The MS-DRG payment includes reimbursement for all of the following inpatient
services except: Answer - Physician hospital visit
Mr. Brown was admitted to the hospital with severe chest pains. During his
encounter he underwent a coronary artery bypass procedure (CABG) due to
coronary artery disease (CAD). What is the first step in determining the MS-
DRG assignment for this encounter? Answer - Determine if the coronary artery
bypass procedure is one of the Pre-MDC procedures
[See pg 117- Step 1: Pre-MDC assignment.]
What is the general term for software that assigns inpatient diagnosis related
groups? Answer - Grouper
[computer programs that assign patients to case-mix groups are generically
called groupers]
