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CDIP Toolkit WITH 100- PASSED ANSWERS.
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11/3/24, 2:48 AM CDIP Toolkit Flashcards | QuizletCDIP Toolkit
WITH 100% PASSED ANSWERS
- MS-DRGs 2007 to reflect SOI/ROM
- POA indicators 2008
- Medicare Advantage/Part C (capitated, HCC)
recent drivers of CDI (p2)
- some payers moving to APR DRGs
- compliance reviews: RAC, Zone Program Integrity Contractors, Medicaid Integ
Contractors
to initiate concurrent and, as appropriate, retrospective reviews of health records for
purpose of CDI program (p2)
conflicting, incomplete, or nonspecific provider documentation.
to identify clinical indicators to ensure that all diagnoses and procedures are
goal of CDI reviews (p2) supported by
ICD-9-CM codes.
• HIM and coding departments
• Case management and utilization review
• Medical staff and physician leadership
• Executive leadership
key CDI stakeholders (p3) • Patient financial services or billing
• Finance and revenue cycle
• Quality and risk management
• Nursing
• Compliance and ethics
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, 11/3/24, 2:48 AM CDIP Toolkit Flashcards | Quizlet
• Obtain clinical documentation that captures the patient severity of illness and risk of
mortality
• Identify and clarify missing, conflicting, or nonspecific physician documentation
related to
diagnoses and procedures
• Support accurate diagnostic and procedural coding, MS-DRG assignment, leading
to
some examples of CDI goals (p4) appropriate reimbursement
• Promote health record completion during the patient's course of care, which
promotes patient safety
• Improve communication between physicians and other members of the healthcare
team
• Provide awareness and education
• Improve documentation to reflect quality and outcome scores
• Improve coders' clinical knowledge
the physician communication tool used concurrently or retrospectively to obtain
documentation clarification.
query (p4) Other terms synonymous with "query" include clarification, clinical clarification,
documentation
alert, and documentation clarification.
To support the request for documentation, clinical indicators and/or medical evidence that prompted the request for
CDI professionals should provide... (p4) clarification.
a process in which the physician can provide any clarification or specificity on the
An electronic query is... (p5) case by creating an electronic document that is linked to the patient's EHR and made
available as a permanent part of the health record metadata.
helps monitor the work of the CDI professional... It is important for a facility to have
The CDI quality assurance (QA) audit tool... checks and balances in place to ensure the highest level of integrity as CDI
(p6) programs mature... It is recommended that each organization specify the frequency
and volume of audits within its departmental policy.
• >80 percent total discharges reviewed
• 15-20 percent physician clarification impact
Possible red/yellow/green benchmarks for • >50 percent severity clarifications
monthly dashboard (individual benchmarks • >80 percent physician response to clinician
on separate flash cards) - benchmarks and • >80 percent physician agreement with clinician
goals need to be set by facility (pp 7-8) • >75 percent CDS/Coder DRG match
• CMI (measured and reported quarterly)
• 80 percent MCC/CC capture rate
• Total discharges available to review »By financial class, e.g., DRG payer vs. no DRG payer
divided by Actual CDI reviews percentage
• Physician clarification impact percentage »The number of clarifications placed by a CDI that had an impact on the DRG
• Severity clarification percentage »The number of clarifications that resulted in a severity change
• Physician response to CDI specialist » The number of times a physician responds to a CDI question
• Physician agreement with CDI specialist = » For agreements, trend if impact was for principal diagnosis, MCC/CC, procedure,
yes present on admission (POA), hospital-acquired condition (HAC), etc.
» For non-agreements, try to understand from the physician why there was a non-
• Physician agreement with CDI specialist = agreement, e.g., did not understand the query, did not have enough clinical
no information to make a judgment, etc. This collaboration fosters better queries and
better understanding on both sides
• CDI specialist/coder DRG match » Use as learning opportunities for both CDI and coding
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