Online Access Free CCDS-O Exam Questions

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."It predicts medical necessity of ordered procedures/treatments."
• B."It determines what you will be reimbursed."
• C."It determines the patient's out of pocket expenses."
• D."It predicts expected resources needed to care for the patient."

Which of the following is true of the RAF metric?

• A.It is a relative measure of the probable costs to meet the healthcare needs of the individual beneficiary.
• B.It predicts how much the individual provider will be reimbursed for the concurrent practice year.
• C.It is used to calculate each primary care office visit reimbursement based on documentation of chronic conditions.
• D.It is based only on demographic factors such as Medicaid status, gender, or aged/disabled.

Upon retrospective review of a patient visit 2 weeks prior, a CDI specialist notes physician documentation stating the following: "Sick Sinus Syndrome in 2016 s/p pacemaker placement. Latest EKG shows normal paced rhythm." There are no codes noted for Sick Sinus Syndrome or the pacemaker. Which of the following is the BEST course of action for the CDI specialist?

• A.Capture code for pacemaker status only.
• B.Ask the coder to re-bill based upon the documentation.
• C.Educate the provider that a pacemaker status code as well as a Sick Sinus Syndrome code should be assigned.
• D.Request the provider amend the codes to reflect the Sick Sinus Syndrome and pacemaker status.

A patient presents for a right inguinal herniorrhaphy in ambulatory surgery and is placed in observation status postoperatively. Provider documentation states: "Observation related to the post procedural urinary retention likely related to benign prostatic hyperplasia or adverse reaction to anesthesia." From this documentation, which of the following is the first-listed diagnosis?

• A.Adverse reaction to anesthetic
• B.Benign prostatic hyperplasia
• C.Urinary retention
• D.Right inguinal hernia

Provider documentation states: "A 72-year-old patient with an active history of colon cancer, status post bowel resection, receiving chemotherapy. Newly diagnosed lung metastasis. Presents with UTI and elevated creatinine. Labs demonstrate a hemoglobin of 7.9, WBC of 2,500, and platelet count of 20,000." Which of the following is the query opportunity that supports a disease interaction that impacts the risk adjustment?

• A.Acute tubular necrosis and UTI
• B.Chemotherapy induced pancytopenia
• C.Colon cancer and chemotherapy
• D.Colon cancer and lung metastasis