HIT 235 MODULE 3 KNOWLEDGE CHECK QUESTIONS WITH VERIFIED SOLUTIONS LATEST UPDATE
2026
What is the estimated IPPS Medicare payment for the following inpatient case?
Patient BB was treated for congestive heart failure. No operating room surgical procedure was
performed. MS-DRG 293 was assigned with a relative weight (RW) of 0.6756. Length of patient stay: 3
days. Hospital adjusted base rate: $7,350.00. - Answers $4,965.66
Which prospective payment system rule or provision was applied in the following case?
A patient was discharged from an inpatient psychiatric facility on Sunday, then readmitted to another
inpatient psychiatric facility on the Tuesday following his discharge from the original facility. This was
considered one continuous stay for the purposes of payment. - Answers interrupted stay
If a hospital treats a high percentage of patients with lower incomes, it receives a percentage add-on
payment applied to its adjusted base rate DRG payment under the Inpatient Prospective Payment
System (IPPS). What is this add-on called? - Answers disproportionate share hospital adjustment
Why does the Home Health Resource Group require the identification of a comorbidity adjustment
category? - Answers to determine the necessity of continued care
How are patient diagnoses identified in the Major Diagnostic Categories (MDCs) within the DRG
system? - Answers by ICD-10-CM diagnosis codes
In the Inpatient Prospective Payment (IPPS) formula used to calculate an acute inpatient hospital's
payment for treating Medicare patients assigned to a DRG, what factor represents the resource
intensity of that DRG classification based on the average resources used to treat all Medicare patients
in the DRG? - Answers relative weight
Course lessons introduced a system of service payments with CMS as a way to control rising costs for
health care services. How many principles were introduced? - Answers 4
Identify the legislation that provided a prospective payment system (PPS) for long-term care inpatient
hospitals (LTCHs), those that treat medically complex patients with an average length of stay greater
than 25 days? - Answers Balanced Budget Refinement Act of 1999 and Benefits Improvement and
Protection Act of 2000
What is the name of the inpatient prospective payment rule, and in what setting does it apply?
The rule identifies qualifying factors in cases where a patient was admitted as an inpatient, and it was
later found, after review, that the case should have been outpatient; services can then be billed as
outpatient. - Answers Condition code 44, acute care hospital
Which of these variables impacting MS-DRG assignment describes a secondary condition that, along
with a principal diagnosis, causes a statistical increase in the length of stay of at least one day in at
least 75 percent of patients with the same principal diagnosis? - Answers complication or comorbidity
(CC)
If the Centers for Medicare and Medicaid (CMS) were to increase the relative weight (RW) shown
below for MS-DRG-X by 15 percent, which MS-DRG can the hospital project to represent greater total
Medicare payment and why?
MS-DRG X - RW 2.0230 Volume of cases 323
MS-DRG Y - RW 1.9256 Volume of cases 402 - Answers MS-DRG Y because the volume of cases is
higher.
What was the goal of the Outpatient Prospective Payment System (OPPS) when it was implemented?
- Answers To shift financial risk to hospitals
As presented in the lesson, CMS has an addendum of payment status indicators. Partial
hospitalization is covered under which status indicator? - Answers P
In an outpatient reimbursement, what determines the payment for the procedure? - Answers
CPT/HCPCS codes
When services with a status indicator are performed, what typically happens to the associated
ancillary items used during that service? - Answers They are packaged into the payment.
Lessons in this module provided the MS-DRG definitions manual. In this manual, headers appear for
many MS-DRG definitions. Which is not a heading provided? - Answers Discharge Status
As presented in the lesson, CMS has an addendum of payment status indicators. Which service is not
included under status indicator K? - Answers Pass-through drugs and biologicals
Why is it important to assign the correct APCs when a patient receives multiple services on the same
day? - Answers APCs have varying reimbursement amounts
2026
What is the estimated IPPS Medicare payment for the following inpatient case?
Patient BB was treated for congestive heart failure. No operating room surgical procedure was
performed. MS-DRG 293 was assigned with a relative weight (RW) of 0.6756. Length of patient stay: 3
days. Hospital adjusted base rate: $7,350.00. - Answers $4,965.66
Which prospective payment system rule or provision was applied in the following case?
A patient was discharged from an inpatient psychiatric facility on Sunday, then readmitted to another
inpatient psychiatric facility on the Tuesday following his discharge from the original facility. This was
considered one continuous stay for the purposes of payment. - Answers interrupted stay
If a hospital treats a high percentage of patients with lower incomes, it receives a percentage add-on
payment applied to its adjusted base rate DRG payment under the Inpatient Prospective Payment
System (IPPS). What is this add-on called? - Answers disproportionate share hospital adjustment
Why does the Home Health Resource Group require the identification of a comorbidity adjustment
category? - Answers to determine the necessity of continued care
How are patient diagnoses identified in the Major Diagnostic Categories (MDCs) within the DRG
system? - Answers by ICD-10-CM diagnosis codes
In the Inpatient Prospective Payment (IPPS) formula used to calculate an acute inpatient hospital's
payment for treating Medicare patients assigned to a DRG, what factor represents the resource
intensity of that DRG classification based on the average resources used to treat all Medicare patients
in the DRG? - Answers relative weight
Course lessons introduced a system of service payments with CMS as a way to control rising costs for
health care services. How many principles were introduced? - Answers 4
Identify the legislation that provided a prospective payment system (PPS) for long-term care inpatient
hospitals (LTCHs), those that treat medically complex patients with an average length of stay greater
than 25 days? - Answers Balanced Budget Refinement Act of 1999 and Benefits Improvement and
Protection Act of 2000
What is the name of the inpatient prospective payment rule, and in what setting does it apply?
The rule identifies qualifying factors in cases where a patient was admitted as an inpatient, and it was
later found, after review, that the case should have been outpatient; services can then be billed as
outpatient. - Answers Condition code 44, acute care hospital
Which of these variables impacting MS-DRG assignment describes a secondary condition that, along
with a principal diagnosis, causes a statistical increase in the length of stay of at least one day in at
least 75 percent of patients with the same principal diagnosis? - Answers complication or comorbidity
(CC)
If the Centers for Medicare and Medicaid (CMS) were to increase the relative weight (RW) shown
below for MS-DRG-X by 15 percent, which MS-DRG can the hospital project to represent greater total
Medicare payment and why?
MS-DRG X - RW 2.0230 Volume of cases 323
MS-DRG Y - RW 1.9256 Volume of cases 402 - Answers MS-DRG Y because the volume of cases is
higher.
What was the goal of the Outpatient Prospective Payment System (OPPS) when it was implemented?
- Answers To shift financial risk to hospitals
As presented in the lesson, CMS has an addendum of payment status indicators. Partial
hospitalization is covered under which status indicator? - Answers P
In an outpatient reimbursement, what determines the payment for the procedure? - Answers
CPT/HCPCS codes
When services with a status indicator are performed, what typically happens to the associated
ancillary items used during that service? - Answers They are packaged into the payment.
Lessons in this module provided the MS-DRG definitions manual. In this manual, headers appear for
many MS-DRG definitions. Which is not a heading provided? - Answers Discharge Status
As presented in the lesson, CMS has an addendum of payment status indicators. Which service is not
included under status indicator K? - Answers Pass-through drugs and biologicals
Why is it important to assign the correct APCs when a patient receives multiple services on the same
day? - Answers APCs have varying reimbursement amounts
