Assume the patient has already met their deductible and that the physician is a non-participating Medicare provider but does accept assignment. The standard fee for the services provided is $120.00. Medicare’s PAR fee is $60.00 and Medicare’s non-PAR fee is $57.00. What is the amount Medicare will pay the provider on this claim?

CMS-identified “hospital-acquired conditions” mean that when a particular diagnosis is not “present on admission,” CMS determines it to be

Of the following, which is a hospital-acquired condition (HAC)?

The following type of hospital is considered excluded when it applies for, and receives, a waiver from CMS. This means that the hospital does not participate in the inpatient prospective payment system (IPPS).

The provider performed an open coronary bypass on two internal mammary arteries, one right, one left. Zooplastic tissue was used. The correct ICD-10-PCS code or codes reported are:

APCs are groups of services that the OPPS will reimburse. Which one of the following services is not included in APCs?

HIPAA administrative simplification provisions require all of the following code sets to be used EXCEPT

Use the following table to answer the question.   MS-DRG Description Number of Patients CMS Relative Weight 470 Major joint replacement or reattachment of lower extremity w/o MCC 2,750 1.9871 392 Esophagitis, gastroent & misc. digestive disorders w/o MCC 2,200 0.7121 194 Simple pneumonia & pleurisy w CC 1,150 1.0235 247 Perc cardiovasc proc 2 drug-eluting stent w/o MCC 900 2.1255 293 Heart failure & shock w/o CC/MCC 850 0.8765 313 Chest pain 650 0.5489 292 Heart failure & shock w CC 550 1.0134 690 Kidney & urinary tract infections w/o MCC 400 0.8000 192 Chronic obstructive pulmonary disease w/o CC/MCC 300 0.8145 871 Septicemia w/o MV 96+ hours w MCC 250 1.7484 Based on the this patient volume, during this time period, the MS-DRG that brings in the highest “total” reimbursement to the hospital is 

Changes in case-mix index (CMI) may be attributed to all of the following factors EXCEPT

Some services are performed by a non-physician practitioner (such as a physician assistant). These services are an integral yet incidental component of a physician’s treatment. A physician must have personally performed an initial visit and must remain actively involved in the continuing care. Medicare requires direct supervision for these services to be billed. This is called