CDIP EVALUATION TEST EXAM 2026 QUESTIONS AND
SOLUTIONS GRADED A+
✔✔Anesthesiologist - ✔✔A query is necessary if there's a conflict between them and
the attending physician.
✔✔AHD - ✔✔American Hospital Directory
✔✔OIG - ✔✔Office of the Inspector General
✔✔QIO - ✔✔Quality Improvement Organization
✔✔ASCQR - ✔✔Ambulatory Surgical Center Quality Reporting
✔✔Recommended Data to review - ✔✔Discharges by service and by MDC, Discharges
by DRG, CMI, Complications and Major Complication Rates, Severity Levels(MS-DRG
and APR-DRG), Medicare Quality Indicators
✔✔FMQAI - ✔✔Florida Medical Quality Assurance Inc.
contracted with CMS to develop the Medication Measures Special Innovation Project
✔✔NQF - ✔✔National Quality Forum
✔✔IQR - ✔✔Inpatient Quality Reporting
✔✔PQRS - ✔✔Physician Quality Reporting System
✔✔CC/MCC focus - ✔✔ARF, Acute respiratory failure, congestive heart failure,
encephalopathy, excision debridement, HIV, AIDS, TB, sepsis, anemia, MI
✔✔MEDPAR - ✔✔Medicare Provider and Analysis Review
✔✔APC - ✔✔Ambulatory Payment Classification.
It allows for multiple assignments for each encounter and for the analysis of clinical
documentation to remain on coding level
✔✔Capture rate - ✔✔Key indicator used to monitor a successful CDI program.
✔✔Ten best CDI Operational Practices - ✔✔1. CDI is Px centered
2. Create a Vision
3. Initial compulsory physician education
4. Creating policies and procedures that require sign-off
5. Maintaining complete query documentation
6. Feedback loop between denials, management, and CDI
, 7. Feedback loop between CDI and compliance
8. Feedback loop between HIM and CDI
9. Continuous targeted physician education and relationship building
10. Using rigorous management tools.
✔✔Organizations responsible for functions that continually integrate with CDI -
✔✔Compliance, HIM, case manager, finance, medical staff, data analysts, case mix
managers, EHR staff
✔✔Key outcomes of CDI - ✔✔High-quality care, high-perceived quality, improved px
satisfaction and accurate reimbursement
✔✔CDI best practices feedback loop with - ✔✔Denials, Management, Compliance,
HIM, CDI program staff
✔✔RAC - ✔✔Recovery Audit Contractors
✔✔MAC - ✔✔Medicare Administrative Contractors
✔✔Best practices for CDI must benefit the system in at least 2 of the following -
✔✔Operation, strategy and compliance
✔✔4 criteria for describing basics of best of practice CDI program - ✔✔• Remain
constant over time (timeless)
• Practice supported by research and actual application by multiple healthcare systems
• Affect at least 2 management areas (operation, strategy and compliance)
• Provide some measurable value to the organization
✔✔HIM - ✔✔CDI staff work directly with HIM staff to obtain data about retrospective
physician query
✔✔5 Best practices for management of financial measures in the CDI program - ✔✔1.
Track CMI closely and identify real patient mix change
2. Track and report on CC rates overall and by service
3. Know the benchmarks and validate the data regularly
4. Do the right thing for the most accurate data outcome
5. Create a concurrent process with physician leadership.
✔✔HIPAA - ✔✔Health Information Portability and Accountability Act
✔✔CMS and OIG - ✔✔The two-part theory for high-quality clinical documentation is a
cause and effect theory is derived from CMS and OIG
SOLUTIONS GRADED A+
✔✔Anesthesiologist - ✔✔A query is necessary if there's a conflict between them and
the attending physician.
✔✔AHD - ✔✔American Hospital Directory
✔✔OIG - ✔✔Office of the Inspector General
✔✔QIO - ✔✔Quality Improvement Organization
✔✔ASCQR - ✔✔Ambulatory Surgical Center Quality Reporting
✔✔Recommended Data to review - ✔✔Discharges by service and by MDC, Discharges
by DRG, CMI, Complications and Major Complication Rates, Severity Levels(MS-DRG
and APR-DRG), Medicare Quality Indicators
✔✔FMQAI - ✔✔Florida Medical Quality Assurance Inc.
contracted with CMS to develop the Medication Measures Special Innovation Project
✔✔NQF - ✔✔National Quality Forum
✔✔IQR - ✔✔Inpatient Quality Reporting
✔✔PQRS - ✔✔Physician Quality Reporting System
✔✔CC/MCC focus - ✔✔ARF, Acute respiratory failure, congestive heart failure,
encephalopathy, excision debridement, HIV, AIDS, TB, sepsis, anemia, MI
✔✔MEDPAR - ✔✔Medicare Provider and Analysis Review
✔✔APC - ✔✔Ambulatory Payment Classification.
It allows for multiple assignments for each encounter and for the analysis of clinical
documentation to remain on coding level
✔✔Capture rate - ✔✔Key indicator used to monitor a successful CDI program.
✔✔Ten best CDI Operational Practices - ✔✔1. CDI is Px centered
2. Create a Vision
3. Initial compulsory physician education
4. Creating policies and procedures that require sign-off
5. Maintaining complete query documentation
6. Feedback loop between denials, management, and CDI
, 7. Feedback loop between CDI and compliance
8. Feedback loop between HIM and CDI
9. Continuous targeted physician education and relationship building
10. Using rigorous management tools.
✔✔Organizations responsible for functions that continually integrate with CDI -
✔✔Compliance, HIM, case manager, finance, medical staff, data analysts, case mix
managers, EHR staff
✔✔Key outcomes of CDI - ✔✔High-quality care, high-perceived quality, improved px
satisfaction and accurate reimbursement
✔✔CDI best practices feedback loop with - ✔✔Denials, Management, Compliance,
HIM, CDI program staff
✔✔RAC - ✔✔Recovery Audit Contractors
✔✔MAC - ✔✔Medicare Administrative Contractors
✔✔Best practices for CDI must benefit the system in at least 2 of the following -
✔✔Operation, strategy and compliance
✔✔4 criteria for describing basics of best of practice CDI program - ✔✔• Remain
constant over time (timeless)
• Practice supported by research and actual application by multiple healthcare systems
• Affect at least 2 management areas (operation, strategy and compliance)
• Provide some measurable value to the organization
✔✔HIM - ✔✔CDI staff work directly with HIM staff to obtain data about retrospective
physician query
✔✔5 Best practices for management of financial measures in the CDI program - ✔✔1.
Track CMI closely and identify real patient mix change
2. Track and report on CC rates overall and by service
3. Know the benchmarks and validate the data regularly
4. Do the right thing for the most accurate data outcome
5. Create a concurrent process with physician leadership.
✔✔HIPAA - ✔✔Health Information Portability and Accountability Act
✔✔CMS and OIG - ✔✔The two-part theory for high-quality clinical documentation is a
cause and effect theory is derived from CMS and OIG
