1|Page
2025 CDIP FINAL EXAM NEWEST VERSION 2025
ACTUAL EXAM COMPLETE 350 QUESTIONS
AND CORRECT ANSWERS WITH RATIONALES
(VERIFIED ANSWERS) |ALREADY GRADED A+
A patient presented to the ED with a fever and WBCs at 25,000.
The patient was experiencing fatigue and altered metal status
and complaint of pain in the pelvic area. The patient also had
elevated blood sugar of 286, was thought to be in ketoacidosis,
and was subsequently admitted. The physician documented
catheter- associated UTI at discharge. Based on the physician
documentation, the CDS may want to query for?
A) UTI being present on admission
B) Type of organism
C) Uncontrolled diabetes
D) No query warranted - ANSWER- A) UTI being present on
admission
To determine whether inpatient admission is reasonable and
payable under Medicare Part A, this rule established a Medicare
payment policy regarding the benchmark criteria of
,2|Page
A) Utilization rule
B) Short stay rule
C) Two midnight rule
D) 80/20 rule - ANSWER- B) Short stay rule
Due to the compliance concerns surrounding the possible
leading queries, CMA has engaged which organization to assist
in record review of certain DRGs and documentation concerns
A) QIO
B) PEPPER
C) ONC
D) Q-Net - ANSWER- A) QIO
Rationale; The QIO (Quality Improvement Organizations)
Program, one of the largest federal programs dedicated to
improving health quality for Medicare beneficiaries, is an
integral part of the U.S. Department of Health and Human
(HHS) Services' National Quality Strategy for providing better
care and better health at lower cost. By law, the mission of the
QIO Program is to improve the effectiveness, efficiency,
economy, and quality of services delivered to Medicare
beneficiaries.
,3|Page
Based on this statutory charge, and CMS's program experience,
CMS identifies the core functions of the QIO Program as:
Improving quality of care for beneficiaries;
Protecting the integrity of the Medicare Trust Fund by ensuring
that Medicare pays only for services and goods that are
reasonable and necessary and that are provided in the most
appropriate setting; and
Protecting beneficiaries by expeditiously addressing individual
complaints, such as beneficiary complaints; provider-based
notice appeals; violations of the
Emergency Medical Treatment and Labor Act (EMTALA); and
other related responsibilities as articulated in QIO-related law.
This document outlines areas of audit review as pursued by the
Department of Health and Human Services by the Office of
Inspector General (OIG)
A) OIG Statement of Work
B) OIG Final Rule
C) OIG Work Plan
D) None of the above - ANSWER- C) OIG Work Plan
, 4|Page
Rationale; The OIG Work Plan outlines areas of audit and
review as pursued by the Department of Health and Human
Services by the Office of Inspector General (OIG). This
document is published and updated yearly.
This government audit agency calculates the national paid
claims error rate for all of the Medicare fee-for-service claims
paid by MACs
A) Comprehensive Error Rate Testing (CERT)
B) Recovery Audit Contractor (RAC)
C) Medicare Administrative Contractor (MAC)
D) No governmental agency regulates error rate - ANSWER-
A) Comprehensive Error Rate Testing (CERT)
The CDS manager is implementing a process to review queries
ongoing for format and appropriateness. This should be done:
A) Weekly
B) Monthly
C) Quarterly
D) Annually - ANSWER- D) Annually
2025 CDIP FINAL EXAM NEWEST VERSION 2025
ACTUAL EXAM COMPLETE 350 QUESTIONS
AND CORRECT ANSWERS WITH RATIONALES
(VERIFIED ANSWERS) |ALREADY GRADED A+
A patient presented to the ED with a fever and WBCs at 25,000.
The patient was experiencing fatigue and altered metal status
and complaint of pain in the pelvic area. The patient also had
elevated blood sugar of 286, was thought to be in ketoacidosis,
and was subsequently admitted. The physician documented
catheter- associated UTI at discharge. Based on the physician
documentation, the CDS may want to query for?
A) UTI being present on admission
B) Type of organism
C) Uncontrolled diabetes
D) No query warranted - ANSWER- A) UTI being present on
admission
To determine whether inpatient admission is reasonable and
payable under Medicare Part A, this rule established a Medicare
payment policy regarding the benchmark criteria of
,2|Page
A) Utilization rule
B) Short stay rule
C) Two midnight rule
D) 80/20 rule - ANSWER- B) Short stay rule
Due to the compliance concerns surrounding the possible
leading queries, CMA has engaged which organization to assist
in record review of certain DRGs and documentation concerns
A) QIO
B) PEPPER
C) ONC
D) Q-Net - ANSWER- A) QIO
Rationale; The QIO (Quality Improvement Organizations)
Program, one of the largest federal programs dedicated to
improving health quality for Medicare beneficiaries, is an
integral part of the U.S. Department of Health and Human
(HHS) Services' National Quality Strategy for providing better
care and better health at lower cost. By law, the mission of the
QIO Program is to improve the effectiveness, efficiency,
economy, and quality of services delivered to Medicare
beneficiaries.
,3|Page
Based on this statutory charge, and CMS's program experience,
CMS identifies the core functions of the QIO Program as:
Improving quality of care for beneficiaries;
Protecting the integrity of the Medicare Trust Fund by ensuring
that Medicare pays only for services and goods that are
reasonable and necessary and that are provided in the most
appropriate setting; and
Protecting beneficiaries by expeditiously addressing individual
complaints, such as beneficiary complaints; provider-based
notice appeals; violations of the
Emergency Medical Treatment and Labor Act (EMTALA); and
other related responsibilities as articulated in QIO-related law.
This document outlines areas of audit review as pursued by the
Department of Health and Human Services by the Office of
Inspector General (OIG)
A) OIG Statement of Work
B) OIG Final Rule
C) OIG Work Plan
D) None of the above - ANSWER- C) OIG Work Plan
, 4|Page
Rationale; The OIG Work Plan outlines areas of audit and
review as pursued by the Department of Health and Human
Services by the Office of Inspector General (OIG). This
document is published and updated yearly.
This government audit agency calculates the national paid
claims error rate for all of the Medicare fee-for-service claims
paid by MACs
A) Comprehensive Error Rate Testing (CERT)
B) Recovery Audit Contractor (RAC)
C) Medicare Administrative Contractor (MAC)
D) No governmental agency regulates error rate - ANSWER-
A) Comprehensive Error Rate Testing (CERT)
The CDS manager is implementing a process to review queries
ongoing for format and appropriateness. This should be done:
A) Weekly
B) Monthly
C) Quarterly
D) Annually - ANSWER- D) Annually
