2024 Hattiesburg Hospital Track Pre-Assessment

1. You are rounding on a patient with COPD exacerbation. You adjust his nebulizer regimen and add a pulse steroid taper due to persistent wheezing on day two of the hospital stay. Since there is active management ongoing, you write an order to change him from Observation to Inpatient. He is not clinically unstable, but he is not progressing as quickly as you wished. The rounding level for this patient (that you spent 15 minutes in total time caring for) would be

2. You are called to see an 81-year-old current smoker with COPD for admission. You review standard admit labs, films, EKGs and note the oxygen initial saturation of 86% which is now 93% on 3 liters and drops to 90% when speaking.  You look at the EKG yourself and make an interpretation.  You feel the patient should be placed in the hospital in inpatient status due to a tenuous pulmonary state.  The admit status level most appropriate for the medical decision making is

3. Using an NPP in a shared clinical decision-making capacity and billing for such has new rules since 2022. You spend 14 minutes on rounds in review of the PA note and in seeing the patient.  You document a note –“see and agree with above” – even though you have been told that the “medical decision making will drive the charge”.  The billing staff sees the note, realizes the lack of documentation will render only a level one visit at best (99231), but notes that you and the PA both documented your time in the encounter.  In the PA note, she mentions 23 minutes for time to see patient, call family, do a note, and review labs.  The billing staff decides to bill based on total time of 37 minutes.  The 37 minutes eclipses the threshold of which rounding visit?

4. CMS includes these conditions/procedures in their 30-day risk-standardized unplanned readmission measures to grade facilities, and if they have excess readmissions as compared to their peers, a reduction in payment can be applied. Which of the conditions below are NOT used in this calculation (select the condition that is NOT included)?

5. The Medicare Spend Per Beneficiary calculation performed by CMS (choose the ONE best answer)

6. The document that is best suited to streamline care transitions from the hospital stay is the discharge summary. Which of the following are noted as being important in capture of the discharge summary? (choose ALL that are correct)

7. Which of the following is a Major Comorbid Condition (MCC)?

8. If a patient has aspiration pneumonia, add which of the following to enhance the DRG? Choose ALL that are correct.

9. Choose the condition coded to the highest level of severity

10. You have a longstanding Medicare patient (not Medicare Advantage) come in with COPD exacerbation. He is not on oxygen at home, and his sats were 77% on RA and did not stabilize until he was placed on BiPAP.  But, this presentation is as before, and he usually stays 4-5 days before stabilizing enough to return home (and most of these hospitalizations requiring BiPAP). He refuses mechanical ventilation and has this noted on his chart.  You expect this admission to be as previous and to stay more than two midnights, so you ordered for inpatient care on admission.  The patient responded more quickly than expected and on the evening rounds of day two, asked to go home.  He is actually on room air, ambulates with stable vitals, and amazingly seems back to baseline.  His family came into town this morning and are here to visit him. They agree to watch over him and to get him in to his PCP tomorrow morning or call back tonight if he worsens.  Clinically, you agree with his request, and you feel good about the discharge plan. Because the patient did not pass two midnights, you should

11. A surgical procedure was admitted electively as “inpatient” for a procedure that is on the “Inpatient Only” list. After the procedure, the Attending Surgeon states she disagrees with that determination because the procedure was “not that hard” and the patient will be going home first of next morning, before the second midnight. You have knowledge of inpatient and observation status determination, so you offer to help her work through this process.  You recommend for her to

12. The CMS Medicare Advantage (MA) Final Rule in 2023 was released partly because

13. Which of the following, if documented correctly, could aid in capturing an inpatient status for the heart failure patient on day ONE? Select all that apply.

14. The session mentioned the use of the HEART and EDACS scores as tools for ED evaluation of chest pain. The HEART score of a patient is 3 and the EDACS is 11.  This would indicate possible 

15. True statements about atrial fibrillation (select all that are TRUE)

16. Which of the following would NOT support continued hospital stay? (Select ALL that apply)

17. CMS includes these conditions in their 30-day risk-standardized unplanned readmission measures to grade facilities. If excess readmissions are realized as compared to their peers, a reduction in payment can be applied.  Which of the conditions below are used in this calculation (select all that are included)?

19. The National Institutes of Health Stroke Scale (NIHSS) is one tool to use to help determine whether a patient deems to meet medical necessity for inpatient level of care.  Which score below is indicative of such consideration from the 15 elements in the tool? (choose the most correct answer)

18. Regarding screening tools for pneumonia, the following is true (select all that are correct): 

20. A 67-year-old hypertensive patient notes RUE clumsiness at his evening meal (8pm).  He presents to the ED where a CT is completed showing no acute CVA.  He is placed in-house for OBSERVATION status. The next morning the speech issues have resolved.  The neurological evaluation occurred at 0700 AM, 11 hours after symptom onset.  No thrombolytics were used.  He is discharged but did complete an MRI that was already scheduled before leaving (but after discharge) It shows a small ischemic infarct that appears new in the basis pontis.  The most appropriate diagnosis for this hospital stay is

21. A 67-year-old hypertensive patient notes RUE clumsiness at his evening meal (8pm).  He presents to the ED where a CT is completed showing no acute CVA.  He is placed in-house for OBSERVATION status. The next morning the speech issues have resolved.  The neurological evaluation occurred at 0700 AM, 11 hours after symptom onset.  No thrombolytics were used.  He idid complete an MRI that was already scheduled before leaving that showed a small ischemic infarct that appears new in the basis pontis.  The most appropriate status for this hospital stay is

22. A condition is noted to be an infection-related condition that is causing organ disfunction that is manifesting as hypotension unresolved by fluid resuscitation requiring vasopressors. The lactate level is >2mmol/L after adequate IVF boluses.  This clinical state is best defined as

23. An 81-year-old female from a local nursing home is being considered for hospitalization due t a UTI. What would lean you towards an inpatient vs observation status determination?  Choose ALL that are appropriate.

24. The following D-Day (day two) findings would merit an observation patient being placed as inpatient EXCEPT