CDIP Toolkit Exam Questions With Complete Solutions

CDIP Toolkit Exam Questions With Complete Solutions recent drivers of CDI (p2) - CORRECT ANSWER - MS-DRGs 2007 to reflect SOI/ROM - POA indicators 2008 - Medicare Advantage/Part C (capitated, HCC) - some payers moving to APR DRGs - compliance reviews: RAC, Zone Program Integrity Contractors, Medicaid Integ Contractors purpose of CDI program (p2) - CORRECT ANSWER to initiate concurrent and, as appropriate, retrospective reviews of health records for conflicting, incomplete, or nonspecific provider documentation. goal of CDI reviews (p2) - CORRECT ANSWER to identify clinical indicators to ensure that all diagnoses and procedures are supported by ICD-9-CM codes. key CDI stakeholders (p3) - CORRECT ANSWER • HIM and coding departments • Case management and utilization review • Medical staff and physician leadership • Executive leadership • Patient financial services or billing • Finance and revenue cycle • Quality and risk management • Nursing • Compliance and ethics some examples of CDI goals (p4) - CORRECT ANSWER • Obtain clinical documentation that captures the patient severity of illness and risk of mortality • Identify and clarify missing, conflicting, or nonspecific physician documentation related to diagnoses and procedures • Support accurate diagnostic and procedural coding, MS-DRG assignment, leading to appropriate reimbursement • Promote health record completion during the patient's course of care, which promotes patient safety • Improve communication between physicians and other members of the healthcare team • Provide awareness and education • Improve documentation to reflect quality and outcome scores • Improve coders' clinical knowledge query (p4) - CORRECT ANSWER the physician communication tool used concurrently or retrospectively to obtain documentation clarification. Other terms synonymous with "query" include clarification, clinical clarification, documentation alert, and documentation clarification. To support the request for documentation, CDI professionals should provide... (p4) - CORRECT ANSWER clinical indicators and/or medical evidence that prompted the request for clarification. An electronic query is... (p5) - CORRECT ANSWER a process in which the physician can provide any clarification or specificity on the case by creating an electronic document that is linked to the patient's EHR and made available as a permanent part of the health record metadata. The CDI quality assurance (QA) audit tool... (p6) - CORRECT ANSWER helps monitor the work of the CDI professional... It is important for a facility to have checks and balances in place to ensure the highest level of integrity as CDI programs mature... It is recommended that each organization specify the frequency and volume of audits within its departmental policy. Possible red/yellow/green benchmarks for monthly dashboard (individual benchmarks on separate flash cards) - benchmarks and goals need to be set by facility (pp 7-8) - CORRECT ANSWER • 80 percent total discharges reviewed • 15-20 percent physician clarification impact • 50 percent severity clarifications • 80 percent physician response to clinician • 80 percent physician agreement with clinician • 75 percent CDS/Coder DRG match • CMI (measured and reported quarterly) • 80 percent MCC/CC capture rate • Total discharges available to review divided by Actual CDI reviews percentage - CORRECT ANSWER »By financial class, e.g., DRG payer vs. no DRG payer • Physician clarification impact percentage - CORRECT ANSWER »The number of clarifications placed by a CDI that had an impact on the DRG • Severity clarification percentage - CORRECT ANSWER »The number of clarifications that resulted in a severity change • Physician response to CDI specialist - CORRECT ANSWER » The number of times a physician responds to a CDI question • Physician agreement with CDI specialist = yes - CORRECT ANSWER » For agreements, trend if impact was for principal diagnosis, MCC/CC, procedure, present on admission (POA), hospital-acquired condition (HAC), etc. • Physician agreement with CDI specialist = no - CORRECT ANSWER » For non-agreements, try to understand from the physician why there was a non-agreement, e.g., did not understand the query, did not have enough clinical information to make a judgment, etc. This collaboration fosters better queries and better understanding on both sides • CDI specialist/coder DRG match - CORRECT ANSWER » Use as learning opportunities for both CDI and coding • Trending actual CMI to goal CMI - CORRECT ANSWER » Can break the trend into medical and surgical CMI --measure quarterly, not monthly. • DRG Proportions - CORRECT ANSWER » Low/high DRGs » Opportunities for DRG movement, e.g., from DRG 193-195, Simple Pneumonia, to DRG 177-179, Respiratory Infections & Inflammations. Non-dashboard areas to potentially monitor (pp 8-9) - CORRECT ANSWER • Top DRGs reviewed, e.g., top 20, top 50, etc. • Quality impact, e.g. core measures, patient safety indicators, POA/HAC, SOI/ROM, heart failure specificity, etc. • Reimbursement due to CDI based on clarification impact (positive or negative) • CDS productivity • Conditions most often queried or require additional or more specific documentation • Clinicians most often queried • ROM and SOI, overall and by physician (increase/decrease) (observed to expected) • DRG payer denials on cases followed by the CDI program, negatively and positively • Documentation habit changes as a result of the CDI program • Volume of post-discharge queries versus concurrent queries • Cost-adjusted CMI (average cost per case)