CDEO EXAM QUESTIONS WITH COMPLETE
SOLUTIONS
(CDPS) Chronic Illness and Disability Payment System Correct
Answers is the risk adjustment model used by Medicaid. Model
most commonly used by Medicare.
2 or more Correct Answers What size practice is considered a
group practice for reporting MIPS?
9 Domains for CMS Part C (5) and D (4) Correct Answers
*staying health: Screenings, tests, and vaccines
*managing chronic (long term) conditions
*member experience with health plan
*member complaints and changes in health plan performance
*health plan customer service
*Drug plan customer service
*member complaints and changes in the drug plans performance
*member experience with the drug plan
*drug safety and accuracy of drug pricing
A CDEO professional to educate providers and facilities
Correct Answers of billing practices or services that have been
identified by the OIG as high risk for fraud and abuse and which
will be the focus of the OIG's audits for the coming year. It may
also help in forming the scope of an audit for a provider or
facility or may influence recommendations given to a practice.
The introductory message to the Work Plan states that the OIG
chooses the composition of the Work Plan by assessing relative
risks in the programs it oversees, identifying areas that are most
in need of attention, and setting priorities for the sequence and
,proportion of resources to be allocated. Also meeting medical
necessity in the documentation for services rendered.
A Qui Tam Relator Correct Answers The Relator in an action
in which the Government intervenes is between 15 and 25
percent of the amount recovered by the government through the
Qui Tam action. The amount will depend upon the extent to
which the Relator substantially contributed to the prosecution.
Payment to the Relator is made from the proceeds received from
the defendant.
accpetable query Correct Answers The query should not be
constructed in a manner that can be interpreted as leading the
physician. Queries can be open, and provide documentation
from the medical record, along with clinical documentation to
obtain and a more concise diagnosis from the physician.
Multiple choice or yes/no queries can also be utilized; however,
it is important when providing choices for physicians to include
the option of other, or if the diagnosis was uncertain, or could
not be determined.
Activity done with intent would be considered fraudulent.
Correct Answers A provider requiring the coding staff to
intentionally code E/M services one level higher than
documented.
Advance Beneficiary Notice (ABN) Correct Answers the
provider must present the patient with a cost estimate for the
proposed procedure or service. CMS instructions stipulate,
"Notifiers must make a good faith effort to insert a reasonable
estimate...the estimate should be within $100 or 25 percent of
, the actual costs, whichever is greater." Medicare allows that an
estimate that substantially exceeds the actual costs "would
generally still be acceptable" because the beneficiary "would not
be harmed if the actual costs were less than predicted."
Anteroposterior, Oblique, and Swimmers Correct Answers
types of radiological views used in a radiology report. Prone is
not a radiological view, but a body position when the patient is
face down.
As a CDI professional, how can you utilize information
provided in the OIG Work Plan to improve documentation?
Correct Answers Review of the OIG Workplan provides
information on services that will be audited by the OIG. It is a
best practice to review the services that appear on the OIG
workplan that you are performing in your office.
Assignment of benefits Correct Answers This is an
authorization form signed by the patient that allows their
insurance carrier to pay the provider directly. Without this, the
payment will go to the beneficiary and the provider will be
required to collect payment from the beneficiary.
basal cell carcinoma (BCC) Correct Answers skin cancer in
the basal cell layer of the epidermis; very common cancer
caused by sun exposure but rarely metastasizes or spreads. Most
common skin cancer.
Benefits of ePrescribing Correct Answers Avoiding errors
caused by illegible handwriting
SOLUTIONS
(CDPS) Chronic Illness and Disability Payment System Correct
Answers is the risk adjustment model used by Medicaid. Model
most commonly used by Medicare.
2 or more Correct Answers What size practice is considered a
group practice for reporting MIPS?
9 Domains for CMS Part C (5) and D (4) Correct Answers
*staying health: Screenings, tests, and vaccines
*managing chronic (long term) conditions
*member experience with health plan
*member complaints and changes in health plan performance
*health plan customer service
*Drug plan customer service
*member complaints and changes in the drug plans performance
*member experience with the drug plan
*drug safety and accuracy of drug pricing
A CDEO professional to educate providers and facilities
Correct Answers of billing practices or services that have been
identified by the OIG as high risk for fraud and abuse and which
will be the focus of the OIG's audits for the coming year. It may
also help in forming the scope of an audit for a provider or
facility or may influence recommendations given to a practice.
The introductory message to the Work Plan states that the OIG
chooses the composition of the Work Plan by assessing relative
risks in the programs it oversees, identifying areas that are most
in need of attention, and setting priorities for the sequence and
,proportion of resources to be allocated. Also meeting medical
necessity in the documentation for services rendered.
A Qui Tam Relator Correct Answers The Relator in an action
in which the Government intervenes is between 15 and 25
percent of the amount recovered by the government through the
Qui Tam action. The amount will depend upon the extent to
which the Relator substantially contributed to the prosecution.
Payment to the Relator is made from the proceeds received from
the defendant.
accpetable query Correct Answers The query should not be
constructed in a manner that can be interpreted as leading the
physician. Queries can be open, and provide documentation
from the medical record, along with clinical documentation to
obtain and a more concise diagnosis from the physician.
Multiple choice or yes/no queries can also be utilized; however,
it is important when providing choices for physicians to include
the option of other, or if the diagnosis was uncertain, or could
not be determined.
Activity done with intent would be considered fraudulent.
Correct Answers A provider requiring the coding staff to
intentionally code E/M services one level higher than
documented.
Advance Beneficiary Notice (ABN) Correct Answers the
provider must present the patient with a cost estimate for the
proposed procedure or service. CMS instructions stipulate,
"Notifiers must make a good faith effort to insert a reasonable
estimate...the estimate should be within $100 or 25 percent of
, the actual costs, whichever is greater." Medicare allows that an
estimate that substantially exceeds the actual costs "would
generally still be acceptable" because the beneficiary "would not
be harmed if the actual costs were less than predicted."
Anteroposterior, Oblique, and Swimmers Correct Answers
types of radiological views used in a radiology report. Prone is
not a radiological view, but a body position when the patient is
face down.
As a CDI professional, how can you utilize information
provided in the OIG Work Plan to improve documentation?
Correct Answers Review of the OIG Workplan provides
information on services that will be audited by the OIG. It is a
best practice to review the services that appear on the OIG
workplan that you are performing in your office.
Assignment of benefits Correct Answers This is an
authorization form signed by the patient that allows their
insurance carrier to pay the provider directly. Without this, the
payment will go to the beneficiary and the provider will be
required to collect payment from the beneficiary.
basal cell carcinoma (BCC) Correct Answers skin cancer in
the basal cell layer of the epidermis; very common cancer
caused by sun exposure but rarely metastasizes or spreads. Most
common skin cancer.
Benefits of ePrescribing Correct Answers Avoiding errors
caused by illegible handwriting
