CCDS CDI and Quality Metrics 2

Question 1

Which quality metric measures the rate of complications that could reasonably have been prevented through optimal care?

Accepted Answer

Patient Safety Indicators (PSIs)

Answer

Patient Safety Indicators (PSIs) are AHRQ-developed metrics that flag potentially preventable complications and adverse events during hospitalization. CDI specialists monitor PSIs because incomplete documentation can cause avoidable PSI flags that negatively impact hospital quality scores.

Question 2

A CDI specialist notices the hospital's Case Mix Index (CMI) dropped after a coding software update. What is the MOST likely explanation?

Accepted Answer

Higher-severity DRGs are being under-coded due to documentation gaps

Answer

A drop in CMI typically signals that high-severity DRGs are not being captured, often because documentation does not support the specificity needed to assign more resource-intensive DRGs.

Question 3

Which of the following is a Hospital-Acquired Condition (HAC) that directly affects Medicare payment if not documented as present on admission?

Accepted Answer

Catheter-associated urinary tract infection (CAUTI)

Answer

CAUTI is one of the CMS-designated Hospital-Acquired Conditions. If a urinary tract infection develops after admission and is not documented as present on admission, Medicare will not reimburse the additional cost of treating that complication.

Question 4

When calculating the Observed-to-Expected (O/E) mortality ratio, a ratio greater than 1.0 indicates:

Accepted Answer

The hospital's mortality is worse than expected

Answer

An O/E ratio above 1.0 means the hospital's actual observed mortality exceeded the risk-adjusted expected mortality, suggesting potential quality concerns.

Question 5

Under the Hospital Readmissions Reduction Program (HRRP), readmissions within how many days of discharge are tracked?

Accepted Answer

30 days

Answer

CMS tracks 30-day readmissions under the HRRP. Hospitals with excess 30-day readmissions for conditions like heart failure, pneumonia, and hip/knee replacement face payment penalties.

CCDS - Certified Clinical Documentation Specialist Practice Test

CCDS - Certified Clinical Documentation Specialist Practice Test

CCDS CDI and Quality Metrics 2