Question 1

A provider has been determined to be a high-cost provider after a total claims cost analysis. The

providers patient panel has an overall low HCC average score. Which of the following is the MOST

likely explanation regarding the low HCC average score?

Options :

A : The provider cares for patients of a higher acuity

B : The provider is failing to capture all relevant diagnoses

C : The provider has a less complex patient population

D : The provider is not reporting unspecified diagnoses

Answer: B

Question 2

A CDI specialist receives a call from a disgruntled provider regarding recent documentation queries.

The provider claims to only have 15 minutes to see patients and does not have time for interruptions

like this if it does not increase reimbursement. Which of the following is the BEST course of action to

effectively facilitate communication?

Options :

A : Explain to the provider that queries may affect reimbursement, however not directly, and he

should comply.

B : Listen to the provider, agree this does not affect reimbursement, and explain that the CDI team

will stop querying.

C : Request a time at the provider's convenience to review the query process and collaborate to

facilitate the best workflow.

D : Call the provider's superior and report him as being non-compliant with organizational processes.

Answer: C

Question 3

Which of the following conditions is commonly treated with the medication sertraline?

Options :

A : Schizophrenia

B : Asthma

C : Depression

D : Heart failure

Answer: C

Question 4

review]

A patient returns to a PCP for follow-up care related to a UTI. The provider documents œstage 3 CKD

as determined by a single eGFR of 52 mL/min. Which of the following actions should the CDI

specialist take?

Options :

A : Add diagnosis of CKD stage 3 to claim, as it is reportable.

B : Review CKD staging criteria with provider.

C : Delete CKD diagnosis from claim as it was not treated during this encounter.

D : Query for stage 4 CKD.

Answer: B

Question 5

Which of the following physician performance metrics BEST illustrates provider engagement with

outpatient CDI specialist?

Options :

A : Query response rates and problem list updates

B : Problem list updates and RAF capture rates

C : Physician MIPS scores and query response rates

D : Physician RAF scores and RAF capture rates

Answer: A

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