CDIP Toolkit questions with verified solution 2023 updated

CDIP Toolkitrecent 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