CCDS Data Analysis 2

Question 1

A CDI manager wants to benchmark their hospital's CMI against peer institutions. Which data source is MOST appropriate?

Accepted Answer

CMS Provider of Services file or Hospital Compare data

Answer

The hospital's internal EHR analytics dashboard

Answer

The state health department's annual discharge report

Answer

The hospital's billing department quarterly revenue reports

Question 2

When analyzing CC/MCC capture rates by physician, a CDI analyst finds that one physician has a significantly lower capture rate than peers. What is the MOST appropriate next step?

Accepted Answer

Conduct a focused chart review to determine if documentation gaps or coding issues are the cause

Answer

Immediately report the physician to compliance

Answer

Remove the physician from CDI monitoring

Answer

Compare the physician's patient volume to peers before drawing conclusions

Question 3

Which statistical measure is BEST used to identify outlier cases where actual LOS far exceeds the expected LOS for the assigned DRG?

Accepted Answer

Standard deviation from the Geometric Mean Length of Stay (GMLOS)

Answer

Mean LOS for all discharges

Answer

Median LOS by service line

Answer

DRG relative weight compared to hospital-wide CMI

Question 4

A CDI program is evaluating its query impact. Which metric DIRECTLY measures the financial effect of CDI activities?

Accepted Answer

Revenue per query or DRG shift value

Answer

Query response rate

Answer

Query agreement rate

Answer

Physician query volume per CDI specialist

Question 5

In a CDI data analysis, 'DRG pairs' are used to:

Accepted Answer

Identify diagnosis groups where documentation of a CC or MCC would change the DRG assignment

Answer

Match similar patients across different hospitals for benchmarking

Answer

Pair CDI specialists with specific physicians for concurrent reviews

Answer

Compare medical versus surgical DRG assignments for the same condition

Question 6

A hospital notices its observed mortality rate is significantly higher than the expected rate for pneumonia patients. The CDI manager suspects documentation deficiency. What is the MOST likely gap?

Accepted Answer

Secondary diagnoses that capture patient complexity are not being documented

Answer

Pneumonia type is not specified

Answer

Attending physicians are not signing discharge summaries within required timeframes

Answer

The hospital is admitting more patients from long-term care facilities