Quality Improvement and Compliance Flashcards
7 cards from real CDIP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Quality Improvement and Compliance flashcards as text
A CDI program wants to reduce the time from patient admission to initial CDI review. Which workflow change would most directly achieve this goal?
Answer: Adopting a concurrent 24-hour review target with electronic worklist prioritization
Concurrent review with a 24-hour target and electronic worklist prioritization ensures timely intervention while the patient is still admitted.
Which ICD-10-CM guideline governs the sequencing of a condition that develops as a complication of a procedure?
Answer: Guideline I.C.19.g for complications of care
ICD-10-CM guideline I.C.19.g provides specific instructions for coding and sequencing complications of surgical and medical care.
A hospital is preparing for a Joint Commission survey. Which CDI-related documentation standard is most likely to be evaluated?
Answer: Timeliness and completeness of medical record entries including discharge summaries
The Joint Commission evaluates medical record completion standards including timeliness of discharge summaries and authentication of entries.
A CDI specialist identifies a patient with chronic kidney disease stage 3 and type 2 diabetes. The physician has not linked them. What is the correct approach?
Answer: Query the physician to determine if the CKD is due to diabetes
ICD-10-CM requires physician documentation of the causal relationship between diabetes and CKD before the combination code can be used.
Which approach is most consistent with an effective CDI compliance program when a physician consistently disagrees with CDI query suggestions?
Answer: Document the physician's response and code based on their documented clinical judgment
When a physician responds to a query and disagrees, the coder must code based on the physician's documented clinical judgment, as only the physician can establish the diagnosis.
A CDI manager is presenting ROI to hospital leadership. Which calculation best demonstrates the financial impact of the CDI program?
Answer: Reimbursement difference between pre-query and post-query DRG assignments multiplied by case volume
Multiplying the reimbursement difference between pre- and post-query DRG assignments by case volume quantifies the direct financial impact of CDI query activity.
Which of the following scenarios best illustrates an 'upcoding' compliance violation?
Answer: Assigning a more severe DRG than the clinical documentation supports to increase reimbursement
Upcoding occurs when codes are assigned to a higher-paying level than the clinical documentation supports, constituting a false claim.