CDIP Quality Improvement and Compliance 3

Question 1

When conducting a focused clinical documentation audit, which sampling methodology provides the most statistically valid results?

Accepted Answer

Random sampling with an appropriate confidence interval

Answer

Random sampling with an appropriate confidence interval ensures results are statistically representative of the entire population.

Question 2

A hospital receives a Medicare Recovery Audit Contractor (RAC) demand letter for overpayment. What is the first step in the appeals process?

Accepted Answer

Request a redetermination from the Medicare Administrative Contractor

Answer

The first level of the Medicare appeals process is a redetermination request submitted to the Medicare Administrative Contractor within 120 days.

Question 3

Which condition requires documentation of the relationship between two diagnoses before a combination code can be used?

Accepted Answer

All of the above

Answer

Combination codes for hypertensive heart disease, diabetic CKD, and sepsis with a localized infection all require physician documentation of the causal relationship.

Question 4

A CDI program's case-mix index has declined over three consecutive quarters despite stable patient acuity. Which action should the CDI manager take first?

Accepted Answer

Analyze query concurrence rates and denial patterns by DRG

Answer

Analyzing query concurrence rates and denial patterns identifies whether the CMI decline is due to documentation gaps, coding issues, or payer denials.

Question 5

Under HIPAA, a CDI specialist reviewing records for quality improvement purposes must ensure that access is limited to:

Accepted Answer

The minimum necessary information to accomplish the task

Answer

HIPAA's minimum necessary standard requires that access to PHI be limited to what is reasonably necessary to accomplish the intended purpose.

(CDIP) Certified Documentation Improvement Practitioner Practice Test

(CDIP) Certified Documentation Improvement Practitioner Practice Test

CDIP Quality Improvement and Compliance 3