CDIP CDI Metrics and Statistics 3 — Questions and Answers
Question 1: A hospital notices its observed-to-expected (O/E) mortality ratio is greater than 1.0. What does this indicate?
- Better-than-expected mortality outcomes
- Higher mortality than predicted by the risk model (Correct answer)
- Lower severity of illness than peer hospitals
- Excellent CDI documentation quality
Correct answer: Higher mortality than predicted by the risk model
An O/E mortality ratio above 1.0 means actual deaths exceed what the risk model predicted, potentially indicating documentation gaps or quality issues.
Question 2: Which of the following CDI metrics is MOST directly tied to MS-DRG reimbursement optimization?
- Query response turnaround time
- Average severity of illness (SOI) score
- Relative weight per discharge (Correct answer)
- Coder productivity rate
Correct answer: Relative weight per discharge
Relative weight per discharge directly reflects the resource intensity assigned by MS-DRGs and is the primary driver of Medicare reimbursement.
Question 3: A CDI team is benchmarking its physician query response rate. The industry benchmark is typically considered to be:
- Above 50%
- Above 70% (Correct answer)
- Above 90%
- Above 99%
Correct answer: Above 70%
A physician query response rate above 70% is commonly cited as a performance benchmark, though best-in-class programs aim for 90%+.
Question 4: Which metric measures the average number of diagnoses documented per inpatient discharge?
- Diagnoses per encounter rate
- Code density (Correct answer)
- Query volume index
- Documentation specificity rate
Correct answer: Code density
Code density (or diagnosis density) tracks the average number of coded diagnoses per discharge, often used to compare documentation thoroughness.
Question 5: A CDI program reports a 'missed opportunity rate.' What does this metric typically represent?
- Cases where no query was sent despite documentation gaps (Correct answer)
- Cases where the physician did not respond to a query
- Cases where a DRG downgrade occurred post-audit
- Cases where the coder disagreed with the CDI specialist
Correct answer: Cases where no query was sent despite documentation gaps
Missed opportunity rate identifies cases where a CDI review was performed but no query was issued despite identifiable documentation gaps.
Question 6: When evaluating CDI productivity, which formula is used to calculate reviews per day?
- Total reviews ÷ total working hours
- Total reviews ÷ total working days (Correct answer)
- Total reviews × average LOS
- Total queries ÷ total discharges
Correct answer: Total reviews ÷ total working days
Reviews per day = total records reviewed ÷ total working days, a standard CDI workload productivity metric.
Question 7: A CDI program's financial impact report shows $1.2M in 'upward DRG shifts.' This figure is BEST described as:
- Net revenue captured after removing downcodes
- The estimated reimbursement increase from cases where queries led to a higher-weighted DRG (Correct answer)
- Total cost savings from reduced LOS
- Gross revenue before payer contractual adjustments
Correct answer: The estimated reimbursement increase from cases where queries led to a higher-weighted DRG
Upward DRG shift value estimates the additional reimbursement attributable to documentation improvements that moved cases to higher-paying DRGs.
CDIP CDI Metrics and Statistics 3
A hospital notices its observed-to-expected (O/E) mortality ratio is greater than 1.0.
What does this indicate?