Quality Improvement and Compliance Flashcards
7 cards from real CDIP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Quality Improvement and Compliance flashcards as text
A hospital's CDI team notices a pattern of sepsis cases documented without meeting Sepsis-3 criteria. Which quality improvement step should come first?
Answer: Perform a root cause analysis to identify the documentation gap
Root cause analysis identifies the underlying documentation gap before implementing corrective actions.
Under the OIG Work Plan, which documentation pattern is most likely to trigger a focused audit of inpatient records?
Answer: High rates of principal diagnosis changes after query
High rates of principal diagnosis changes after query can signal inappropriate query practices and are an OIG audit trigger.
A CDI specialist finds that a query was leading because it listed only DRG-favorable diagnoses. Which standard does this violate?
Answer: The ACDIS/AHIMA query practice brief
The ACDIS/AHIMA CDI query practice brief explicitly prohibits leading queries that suggest financially advantageous diagnoses.
Which metric best measures CDI program effectiveness in improving specificity of documented diagnoses?
Answer: CC/MCC capture rate
The CC/MCC capture rate directly reflects how often complications and comorbidities are documented with sufficient specificity.
A quality review reveals coders are querying for conditions that clearly exist in the record without physician attestation. What is the most appropriate corrective action?
Answer: Stop all queries and re-train on query indications
Queries are only appropriate when documentation is unclear, incomplete, or conflicting—not for conditions already clearly documented.
Which federal statute imposes civil monetary penalties for knowingly submitting false claims to Medicare or Medicaid?
Answer: False Claims Act
The False Claims Act imposes civil penalties up to three times the amount of the false claim plus per-claim fines.
A CDI program tracks 'query response rate' as a KPI. What does this metric measure?
Answer: The percentage of issued queries that receive a physician response
Query response rate measures the proportion of queries that physicians answer, reflecting physician engagement with the CDI process.