Page 1 of 149 1 CDIP EXAM (CERTIFIED DOCUMENTATION INTEGRITY PRACTITIONER) LATEST 2024 -2025 COMPLETE 450 QUESTION S AND ANSWERS ALREADY GRADED A+ JUST RELE ASED A patient presented to the ED with a fever and WBCs at 25,000. The patient was experiencing fatigue and altered metal status an d 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 A) Utilization rule B) Short stay rule C) Two midnight rule D) 80/20 rule - ANSWE R-B) Short stay rule Page 2 of 149 2 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 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. Based on this statutory charge, and CMS's prog ram 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 nec essary 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) Page 3 of 149 3 A) OIG Statement of Wo rk B) OIG Final Rule C) OIG Work Plan D) None of the above - ANSWER -C) OIG Work Plan 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 p ublished 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 forma t and appropriateness. This should be done: A) Weekly B) Monthly C) Quarterly Page 4 of 149 4 D) Annually - ANSWER -D) Annually In 1990, 3M created which DRG system that several states use for Medicaid reimbursement and is also used by facilities to analyze some portion o f the data for Medicare Quality Indicators. What is this system called? A) MS -DRGs B) AP -DRGs C) APR-DRGs D) CPT -DRGs - ANSWER -C) APR -DRGs When trying to determine if documentation is present to substantiate status asthmaticus, the coder should review the record for what terms and phrases? A) Intractable pneumonia B) Refractory asthma and severe, intractable wheezing C) Airway obstruction rel ieved by bronchodilators D) Limited but pronounced wheezing - ANSWER -B) Refractory asthma and severe, intractable wheezing Mechanical ventilation codes require consideration of: A) The time when a tracheal tube is inserted B) The replacement of an endotracheal tube
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