HIT 230 MODULE 6-10 EXAM
QUESTIONS AND ANSWERS GRADED A+
2026
Which of the following concepts is a guiding principle for prospective payment? -
ANS 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. - ANS 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? - ANS Case mix index
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 1
, [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? - ANS (federal payment rate *
labor portion * WI) + (federal payment rate * non-labor portion)
What is the basis of the "labor-related share"? - ANS 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? - ANS Federal Register
The MS-DRG payment includes reimbursement for all of the following inpatient services except:
- ANS 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? -
ANS 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? -
ANS Grouper
[computer programs that assign patients to case-mix groups are generically called groupers]
Which IPPS provision is provided to facilities that experience a financial hardship because they
provide treatment for patients who are unable to pay for the services? -
ANS Disproportionate share hospital
Which of the following IPPS provisions provides the hospital with a hospital specific
reimbursement amount? - ANS Indirect medical education &
High cost outlier cases
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 2
QUESTIONS AND ANSWERS GRADED A+
2026
Which of the following concepts is a guiding principle for prospective payment? -
ANS 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. - ANS 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? - ANS Case mix index
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 1
, [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? - ANS (federal payment rate *
labor portion * WI) + (federal payment rate * non-labor portion)
What is the basis of the "labor-related share"? - ANS 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? - ANS Federal Register
The MS-DRG payment includes reimbursement for all of the following inpatient services except:
- ANS 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? -
ANS 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? -
ANS Grouper
[computer programs that assign patients to case-mix groups are generically called groupers]
Which IPPS provision is provided to facilities that experience a financial hardship because they
provide treatment for patients who are unable to pay for the services? -
ANS Disproportionate share hospital
Which of the following IPPS provisions provides the hospital with a hospital specific
reimbursement amount? - ANS Indirect medical education &
High cost outlier cases
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 2
