Question 1

A provider has been determined to be a high-cost provider after a total claims cost analysis. The

providers patient panel has an overall low HCC average score. Which of the following is the MOST

likely explanation regarding the low HCC average score?

Options :

A : The provider cares for patients of a higher acuity

B : The provider is failing to capture all relevant diagnoses

C : The provider has a less complex patient population

D : The provider is not reporting unspecified diagnoses

Answer: B

Question 2

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

Question 3

If a patient is being seen for follow-up and the documentation indicates that the patient was

admitted to the hospital 28 days ago with an acute cerebral infarction with remaining right-sided

weakness, which of the following diagnoses would be MOST appropriate?

Options :

A : Cerebral infarction, unspecified, hemiparesis affecting right dominant side

B : Hemiparesis following cerebral infarction affecting unspecified side

C : Hemiparesis following cerebral infarction affecting right dominant side

D : Other sequelae of cerebral infarction

Answer: C

Question 4

review]

A patient returns to a PCP for follow-up care related to a UTI. The provider documents œstage 3 CKD

as determined by a single eGFR of 52 mL/min. Which of the following actions should the CDI

specialist take?

Options :

A : Add diagnosis of CKD stage 3 to claim, as it is reportable.

B : Review CKD staging criteria with provider.

C : Delete CKD diagnosis from claim as it was not treated during this encounter.

D : Query for stage 4 CKD.

Answer: B

Question 5

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

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