CPB (Certified Professional Biller) Certification Practice Exam

What determines the reimbursement rates for severity of illness and risk of mortality under the ARP-DRG system?

1. Minor and moderate subclasses

2. Major and extreme subclasses

3. Superficial and deep subclasses

4. Minute and significant subclasses

The correct answer is: Major and extreme subclasses

The correct answer reflects the fact that the ARP-DRG (All Patient Refined Diagnosis Related Groups) system categorizes patients based on the severity of their illness and the risk of mortality. The system specifically utilizes major and extreme subclasses to determine reimbursement rates effectively. Major subclasses correspond to a higher level of severity and indicate that a patient’s condition requires more intensive resources and care, which justifies higher reimbursement rates. Extreme subclasses represent cases that pose the highest risk of mortality and indicate that the treatment and care needed are significantly more complex and resource-intensive. This hierarchy ensures that reimbursement is aligned with the intensity of the medical services required, thus providing a more equitable and accurate payment structure for healthcare providers based on the needs of their patients. The other terminology options listed do not align with the designations used in the ARP-DRG system and do not reflect the necessary granularity required for proper classification, which reinforces why major and extreme subclasses are essential for determining reimbursement rates accurately.