Question 1

Which of the following contributes to the risk adjustment score under the CMS-HCC model?

Options :

A : Income status and disability status

B : Health status and previous risk score

C : Enrollment eligibility status and reported conditions

D : Cost of care provided and hospital readmissions

Answer: C

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 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

Question 4

Documentation from which of the following facility settings contributes to the CMS-HCC risk score?

Options :

A : Freestanding ambulatory surgical center

B : Hospital ambulatory clinic

C : Hospice care

D : Renal dialysis center

Answer: B

Question 5

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 patients 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?

Options :

A : Megace and ferrous sulfate

B : Metformin and methotrexate

C : NovoLog and Lasix

D : Wellbutrin and Allegra

Answer: C

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