CRC Clinical Documentation Improvement 3

Question 1

A CDI program is implementing risk adjustment-focused outpatient reviews. Which approach is most effective for condition capture?

Accepted Answer

Focus on patients with known chronic conditions whose annual wellness visits are approaching

Answer

Targeting patients with chronic conditions around annual wellness visits maximizes impact with focused resources.

Question 2

A provider documents 'dementia' in a 78-year-old patient. Which CDI query elements are essential?

Accepted Answer

Dementia type, etiology, and any behavioral disturbances

Answer

The query should address type, etiology, and behavioral disturbances. Dementia with behavioral disturbance maps to a higher-severity HCC.

Question 3

The discharge summary says 'acute kidney injury' while the nephrology consultation documents 'acute on chronic kidney disease stage 3.' Which documentation should drive CDI action?

Accepted Answer

A CDI query should reconcile the conflicting documentation

Answer

Conflicting documentation requires reconciliation by the attending physician.

Question 4

A CDI team is measuring financial impact of their risk adjustment program. Which metric best demonstrates value?

Accepted Answer

Net RAF score change attributable to CDI-identified improvements

Answer

Net RAF score change directly quantifies financial impact and can be converted to dollar impact.

Question 5

In which scenario is retrospective CDI review more appropriate than concurrent review?

Accepted Answer

When analyzing prior year encounter data to identify systematic documentation gaps

Answer

Retrospective CDI is most appropriate for analyzing historical data to identify systematic patterns and inform future documentation improvement.

(CRC) Certified Risk Adjustment Coder Practice Test

(CRC) Certified Risk Adjustment Coder Practice Test

CRC Clinical Documentation Improvement 3