Know How Hierarchical Condition Categories (HCCs) and Diagnosis Related Groups (DRGs) Shape Clinical Documentation Improvement in 2022 – Post Test

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Question 1 of 10

1. Question
1. Which statement is false regarding a DRG? A DRG …
- a. Is a measure to show the “degree of sickness” of a condition with hospitalized patients
- b. Can be modified by noting comorbid conditions and comorbidities
- c. Is a payment category that is used for the purpose of reimbursing hospitals for a fixed fee regardless of the actual costs incurred for a patient’s care
- d. Is applied on inpatient and outpatient services
Question 2 of 10

2. Question
2. True comments related to the “risk score” in clinical documentation include all EXCEPT:
- a. Higher scores indicate a higher clinical “risk” and usually higher “cost” of care
- b. It is captured when a diagnosis is added to the claim billed for an office visit
- c. The risk score for diabetes is the same as diabetes with nephropathy
- d. Lower risk score capture may negatively impact revenues allotted to the health plan to be used in patient care delivery
Question 3 of 10

3. Question
3. Which of the following is a Major Comorbid Condition (MCC)?
- a. Heart failure, unspecified
- b. Acute systolic heart failure
- c. Left heart failure
- d. Diastolic Dysfunction
Question 4 of 10

4. Question
4. The Medicare Spend Per Beneficiary calculation performed by CMS is
- a. Publicly reported, price standardized, risk adjusted measure. Tied to individual clinicians by NPI/TIN
- b. Used for the Merit Based Incentive Payment System (MIPS)
- c. Calculated using the total spend for 3 days before inpatient “index” admission to 30 days after discharge
- d. All of the above are true
Question 5 of 10

5. Question
5. A 65 year old female developed a nodule on the left thyroid gland and it was removed surgically after FNA showed malignancy. It was completely excised and lymph nodes were removed and all negative. She was released from ENT back to her PCP for long term management. This occurred last year and you are seeing her for the first time this year and you diagnose her with a “History of Papillary Thyroid Cancer”. Which of the following is correct?
- a. This should not be listed “history of” because it has not been seven years post thyroidectomy
- b. “History of” in HCC means only 50% of the risk score will be applied
- c. “History of” is correct and the risk score still is applied at 100%
- d. “History of” is correct and the risk score for this condition will be 0
Question 6 of 10

6. Question
6. A 78 year old male is having numbness in his lower extremities from DMII of 40 years duration. His last A1c was 6.9. Medications have controlled his symptoms. His microalbumin was 40. You diagnose him with diabetic neuropathy as well as diabetic nephropathy. It is January and this is the first visit with you this year. True statements include: (choose all that apply)
- a. Both diseases need to be added to the note (the A/P) and added to the bill today since you assessed both conditions and it is a new year so codes need to be captured
- b. Adding both diseases will double the risk score
- c. The risk score for diabetes with a chronic complication is about three times that of the diabetes without complications risk score
- d. The diabetes diagnosis, the neuropathy diagnosis, and the proteinuria diagnosis should all be added separately to optimize the risk score
Question 7 of 10

7. Question
7. The Principal Diagnosis (reason for admission) and all secondary diagnoses (impacting condition) and procedures related to the admission come together to make the
- a. Case Mix Index (CMI)
- b. Comorbidities and Complications (CCs)
- c. Major comorbidities and complications (MCCs)
- d. Diagnosis Related Group
Question 8 of 10

8. Question
8. Which condition has the highest risk score?
- a. Acute Renal Failure
- b. Stage III chronic kidney disease
- c. Stage IV chronic kidney disease
- d. Stage V chronic kidney disease
Question 9 of 10

9. Question
9. CMS uses risk adjustment when calculating the relative performance of a Medicare-enrolled provider on such metrics as:
- a. Per capita costs for Medicare patients attributed to the provider
- b. Per capita costs for Medicare patients with specific conditions (DM, COPD, etc.)
- c. All-cause hospital readmissions
- d. All of the above
Question 10 of 10

10. Question
10. A right-handed patient presents to your office for a routine follow-up of his hypertension, diabetes, and hyperlipidemia. He had a CVA four years ago with residual paresis in his left hand and upper extremity. Physical therapy has completed their work. With respect to the stroke condition, the best way to capture that diagnosis is to use a code for
- a. History of CVA
- b. History of CVA with left arm weakness
- c. Residual left non-dominant arm weakness due to past CVA
- d. None of the above are correct

Know How Hierarchical Condition Categories (HCCs) and Diagnosis Related Groups (DRGs) Shape Clinical Documentation Improvement in 2022 – Post Test

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