Author Question: Maximizing reimbursement is not permitted because it involves selecting and reporting as principal ... (Read 43 times)

fahad · **on:** Jun 27, 2018

Maximizing reimbursement is not permitted because it involves selecting and reporting as principal diagnosis the code that results in the highest level of reimbursement for the facility, whether that diagnosis meets the criteria for selection or not. One aspect of maximizing reimbursement involves __________.
a. adhering to medical necessity requirements by limiting documentation requirements
b. optimizing third-party payment by assigning codes to diagnoses, procedures, or services
c. reporting codes for documented diagnoses, procedures, or services provided to patients
d. upcoding diagnoses, procedures, or services that are not supported by documentation

Question 2

Determining which of several diagnoses to report as the principal diagnosis when multiple diagnoses equally meet the criteria for selection as the principal diagnosis is called __________, and it is permitted under the inpatient prospective payment system.
a. maximizing payment
b. optimizing reimbursement
c. unbundling procedures
d. upcoding diagnoses