Which of the following therapies is MOST likely to be recommended?

What diagnoses are included in code category N18, chronic kidney disease?

PCP notes describe declining renal function with creatinine trending upward over the last 12 months. Nephrology consult ordered. Which of the following diagnostic tests could support a query to identify status of the patient’s baseline renal function?

A patient was recently admitted to the hospital for emphysema, end stage COPD, and heart failure. The patient was discharged on home oxygen. In preparation for the patient’s upcoming PCP visit, the MOST important query opportunity for a CDI specialist is which of the following?

In which of the following situations would a yes/no query format be considered compliant?

A patient presents to the office complaining of lower abdominal pain and burning urination. Urinalysis indicates WBC >10, positive nitrites, and leuk esterase. Documentation identifies pain, urinary frequency, and fever likely UTI. Cultures are pending for E-Coli. The patient is started on antipyretics and Levaquin. Which of the following conditions can be reported?

Upon review of payer data, a decrease in RAF scores for the organization is noted. After reviewing internal metrics, a CDI specialist notes an increase in the volume of HCC queries across the organization, with accurate coding confirmed. Which of the following is the MOST plausible explanation for these findings?

After a CDI specialist describes how RAF is calculated, a provider states, “I just don’t see how this impacts patient care.” Which of the following is the MOST appropriate response related to the RAF score?

A female patient presents for her yearly wellness check-up. Her vital signs are within normal limits with the exception of dyspnea. Her weight is 165 lbs, up 10 lbs from her previous clinic visit 2 weeks prior. Problem list includes diagnoses of obesity, COPD, heart failure, and diabetes without complications. The patient’s A1c noted 9.2 up from 7.2 from previous year wellness exam. Based on the clinical indicators, which of the following medications should be evaluated and addressed during this clinic visit?

Which of the following adds weight to the risk score over and above the CMS-HCC weights for individual conditions?

A 76-year-old patient presents for a wellness visit. The patient’s vitals are BP 120/80, T 98.7, R 19, and there are no abnormal findings in the exam. The patient has COPD, home oxygen, anemia, hypertension, diabetes, fatigue, and weakness. The patient’s medications are called into the pharmacy and home health resource of choice. Which of the following is the BEST query option?

Given the following CMS-HCC categories, which is the correct order (highest to lowest) in the hierarchy?

A patient is seen at the clinic for a fever, and the provider documents possible Zika virus. A CDI specialist reviews the record and notes that a positive serology test indicates the Zika virus. Which of the following should the CDI specialist do NEXT?

Which of the following are appropriate clinical indicators to support a query related to alcohol dependency in remission?

When reviewing physician metrics, a CDI specialist notes upward trends in the use of unspecified diagnoses. Which of the following diagnoses provides the BEST opportunity to positively influence the providers’ RAF score in the CMS-HCC model?

Provider documentation states: “Type 2 Diabetes with bilateral peripheral arteriosclerotic disease of LE. Bilateral pedal pulses present. Review Hgb A1C and CBC. No change in treatment. Hypertension evaluated and well controlled on Lopressor.” Which of the following conditions should be coded?

A patient receives treatment for diabetes during a primary care visit. He has a glucose level of 240 and A1C of 7.9. The patient is prescribed Gabapentin 100mg TID. Which of the following should the CDI specialist query for?

Which of the following concepts BEST reflects how risk adjustment is related to cost efficiency metrics?

While away on vacation, a patient sustained a compound right femoral shaft fracture requiring ORIF. Upon the patient’s return home, the fracture site is determined by the orthopedist to be healing well without any complication. Which of the following diagnoses is MOST appropriate for this office follow-up?

CMS-HCCs are used to

A morbidly obese patient with a BMI of 45 who is reliant on CPAP at night is likely to have which of the following conditions?

Clinic documentation states: “Follow-up for post-induction chemotherapy for metastatic uterine cancer.” To BEST identify the conditions being monitored and treated, a CDI specialist should

Which entity is tasked by CMS to process both Part A and Part B beneficiary claims?

When evaluating a CDI specialist's performance, which of the following expectations is held to the same standard for both inpatient and outpatient initiatives?

A patient with stage 3 CKD presents to the clinic for evaluation. Upon review of labs, an elevated iPTH and a normal phosphorus level are noted. Which of the following diagnoses may be appropriately queried based upon these lab values?

Documentation states: “Patient with history of STEMI five weeks ago. Returning to office for follow-up. Problem list includes CAD, hypertension, heart failure, leukemia, malnutrition, and atrial fibrillation, all were relevant to the encounter. CBC and WBC reviewed and referred to oncologist. Follow-up with dietitian to further evaluate nutritional status.” Which of the following is the MOST impactful risk adjusted query opportunity?

An African American male enrolled in Medicaid has not been taking his blood pressure medication. Which of the following factors impacts this beneficiary’s risk score?

Which of the following physician performance metrics BEST illustrates provider engagement with outpatient CDI specialist?

Using the table above, which of the following HCC(s) should be assigned for documentation stating the patient has resolving AKI due to ATN, creatinine levels slowly returning to baseline, and CKD- stage 3-4?

An elderly patient with a PMH of CHF, DM type 1, arthritis, and HTN is seen in the clinic for a follow-up appointment after a recent hospitalization. After an evaluation of the patient's current health status, the provider documents the following: "HFrEF: lungs clear, no edema, continue meds. DM: no changes to insulin pump. Arthritis: asymptomatic joint destruction. HTN: BP stable. Continue meds." Which of the following is the clarification opportunity in the above scenario?

Based on previous documentation, which of the following diagnoses would a CDI specialist be MOST likely to bring to the provider’s attention in preparation for an upcoming visit of a 70-year-old patient?

A record review conducted prior to a primary care appointment indicates a patient has been followed for history of colon cancer. The patient is 18 months s/p bowel resection and is under treatment for LLE DVT, which required monitoring of INR - on Coumadin. The problem list also includes obesity, obstructive sleep apnea (OSA), COPD, and hypertension. Which of the following is the query opportunity?

A female patient who underwent total hip replacement 2 weeks ago is in for a follow-up visit with her PCP. The visit note states: “Patient complains of fatigue and lethargy. Hgb on discharge was 10.4gm/dL - now is 8.6 gm/dL. Will start FeSO4 325mg po daily with food. Repeat H/H in 2 weeks. She has return visit with Ortho then.” Which of the following is the BEST course of action for the CDI specialist?

Which of the following conditions or findings supports a diagnosis of diabetes?

The primary purpose of the RADV program is to

Which of the following is a leading query?

Which of the following health record elements impacts HHS-HCC risk scores?

Which of the following BEST defines a risk score under the CMS-HCC model?

When compliantly querying providers, CDI specialists or HIM/coding professionals may

Which of the following is a strategy that is often used by ACOs to improve their performance in the Readmission Reduction program?

A patient presents to the clinic with indwelling Foley catheter, symptoms of fatigue, and low back pain with BPH. Labs reveal WBC 20, and the urine culture is positive for E. coli. Prescription antibiotics are ordered for a UTI. Which of the following is the BEST query opportunity?

Which of the following is a key component that is used to calculate Relative Value Units (RVUs)?