CDIP Regulatory and Payer Requirements 4

Question 1

Under HIPAA, what is the minimum necessary standard as it relates to protected health information (PHI) in the context of CDI?

Accepted Answer

Access to PHI should be limited to the minimum needed to accomplish the intended purpose

Answer

The HIPAA minimum necessary standard requires that disclosures and uses of PHI be limited to the least amount needed to accomplish the intended purpose.

Question 2

Which CMS program penalizes hospitals with excess readmissions for specific conditions such as heart failure, pneumonia, and hip/knee replacement?

Accepted Answer

Hospital Readmissions Reduction Program (HRRP)

Answer

The HRRP reduces Medicare payments to hospitals with higher-than-expected 30-day readmission rates for specified conditions.

Question 3

A query sent to a physician to clarify a diagnosis for CDI purposes must conform to which key compliance principle?

Accepted Answer

Queries must be compliant, non-leading, and clinically supported by health record documentation

Answer

AHIMA and ACDIS guidelines require that physician queries be non-leading, clinically supported, and compliant to avoid fraudulent documentation.

Question 4

Medicaid is jointly funded by which two entities?

Accepted Answer

Federal government and state governments

Answer

Medicaid is a joint federal-state program where both the federal government and individual state governments share funding and administration.

Question 5

The Hospital-Acquired Condition Reduction Program (HACRP) penalizes hospitals that rank in which quartile for HAC rates?

Accepted Answer

Top 25% (highest HAC rates — worst performers)

Answer

HACRP reduces Medicare payments by 1% for hospitals in the worst-performing quartile (top 25% highest HAC rates).

(CDIP) Certified Documentation Improvement Practitioner Practice Test

(CDIP) Certified Documentation Improvement Practitioner Practice Test

CDIP Regulatory and Payer Requirements 4