chapter 7: Healthcare Facility CDI Program Analysis

Question 1

Four primary metrics to measure CDI Programs

Answer 1

1. CDI Staff Productivity (number of records reviewed, queries submitted, responses received)
   2 and 3. Actual documentation improvement that results in improved hospital and physician profiles
2. Accurate hospital reimbursement

Question 2

True or False:
For MS DRGs: Relative weights change with each DRG

Answer 2

True

Question 3

True or False:
for All Patient Refined DRGs (APR DRG) a change in severity level within a DRG does not result in a different RW

Answer 3

False.
It results in a change

Question 4

Productivity Metrics

Answer 4

Review Rates
Query Rates
Response Rates

Question 5

Program Success Metrics

Answer 5

CMI
SOI/ROM
CC/MCC Capture Rates
High Frequency DRGS
Value Based Purchasing and PSIs

Question 6

RAMR

Answer 6

Risk Adjusted Mortality Rate : adjusted for predicted risk of death

Question 7

PEPPER

Answer 7

Program for Evaluating Payment Patterns Electronic Report (PEPPER) : metric is CC

Question 8

Healthgrades

Answer 8

external organization that provides information based on surveys directly from patients

Question 9

Formula for Financial Reimbursement for a DRG

Answer 9

DRG Relative Weight X Facility blended/base rate

The DRG Weight is multiplied by a standardized amount (figure representing the average price per case for all Medicare cases during the year)