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問題 #105
A CDI specialist manager is reviewing the productivity metrics of the outpatient team and notes that one of the CDI specialists has a high query rate and a good physician response, but a low physician agree rate compared to the rest of the team. This likely indicates which of the following?
答案：D
解題說明：
A high query rate with a strong physician response rate shows the CDI specialist is generating many queries and providers are opening/responding to them. However, a consistently low agree rate indicates providers frequently select "disagree," "clinically undetermined," or otherwise do not validate the query's suggested clarification. In outpatient CDI program management, that pattern most often reflects query quality problems-for example, queries that are not well-supported by encounter-specific clinical indicators, queries that are vague or overly speculative, or queries that do not align with outpatient reportability standards (e.g., prompting for diagnoses not clearly monitored/evaluated/assessed/treated). While leading queries are a compliance concern, the more direct operational inference from "high volume + answered + not agreed with" is that the queries are not clinically compelling or are poorly constructed, resulting in frequent provider non-concurrence. Case complexity alone would not reliably drive low agree rates if the queries were appropriately targeted and evidence-based. Therefore, the most likely interpretation is poor-quality queries requiring coaching on clinical support, clarity, and compliant construction.
問題 #106
Which of the following contributes to the risk adjustment score under the CMS-HCC model?
答案：B
解題說明：
Under the CMS-HCC risk adjustment methodology, the RAF is calculated primarily from two categories of inputs: (1) demographic/enrollment eligibility factors and (2) diagnosis codes that map to HCCs based on documented, reportable conditions. Eligibility status matters because Medicare models differentiate beneficiaries by factors such as aged versus disabled status and other enrollment characteristics that affect expected cost. The second major driver is the set of valid, supported ICD-10-CM codes reported for the beneficiary during the data collection period; only certain chronic, clinically significant conditions map to HCCs, and they must be documented as active and applicable to the encounter and coded correctly. In ambulatory CDI, this is why accurate condition capture, specificity, and linkage (e.g., cause/manifestation relationships) are emphasized-because reported conditions directly affect the patient's risk profile and the expected cost benchmark. By contrast, income status is not a standard CMS-HCC input, "previous risk score" is not itself an input variable, and utilization outcomes like cost of care or readmissions are not used to compute RAF (they may be evaluated separately in quality/cost programs).
問題 #107
A CDI specialist read the most recent AHA Coding Clinic that provided updated guidance related to a prior AHA Coding Clinic. The CDI specialist should
答案：C
解題說明：
AHA Coding Clinic guidance functions as an authoritative interpretive resource for correct ICD-10-CM/PCS code assignment when official guidelines or code descriptors need clarification. When Coding Clinic publishes an update that revises, clarifies, or supersedes earlier advice, outpatient CDI practice is to operationalize the newest guidance prospectively-meaning it should be applied going forward from the publication/effective timeframe of that update. This supports consistent, defensible coding and reduces compliance risk by aligning current reporting with the most current official interpretation. Applying the original advice for a calendar or fiscal year (choices A and B) is not how Coding Clinic updates are intended to be implemented; the governing principle is "most current advice controls" once released. Similarly, automatically applying updated guidance retroactively to cases from last year (choice D) is not routine CDI practice; retrospective rebilling or recoding is typically limited, policy-driven, and subject to payer rules, auditing constraints, and organizational compliance decisions. Therefore, the best action is to use the updated Coding Clinic guidance from the date it is published/implemented forward.
問題 #108
Which of the following therapies is MOST likely to be recommended?
答案：B
解題說明：
Metoprolol is a beta-blocker commonly used in atrial fibrillation to achieve ventricular rate control, reduce symptoms (palpitations, dyspnea), and improve hemodynamic stability, especially when the rhythm is persistent or recurrent. From an outpatient CDI chart-review perspective, therapy-to-diagnosis consistency is a key clinical indicator that supports clarifying the condition being treated and ensuring it is documented as assessed/managed at the encounter. The other options are clinically mismatched: "Ensure" is a nutritional supplement typically used for inadequate intake or weight loss and would not be recommended for morbid obesity; rivaroxaban (Xarelto) is an anticoagulant and would be inappropriate in the setting of hematemesis (active GI bleeding) where anticoagulation generally increases risk and would typically be held or reassessed; tamoxifen is an endocrine therapy for hormone receptor-positive breast cancer risk/treatment and is not a standard therapy for chronic congestive heart failure. Therefore, metoprolol for atrial fibrillation is the most appropriate and likely recommendation among the choices.
問題 #109
Documentation from which of the following facility settings contributes to the CMS-HCC risk score?
答案：D
解題說明：
Under CMS-HCC risk adjustment (commonly applied to Medicare Advantage), qualifying diagnoses must come from acceptable encounter/claim sources and eligible provider types. Hospital-based outpatient services (including a hospital ambulatory clinic) are among the standard, acceptable settings where diagnoses documented, coded, and submitted on qualifying encounters may be used for risk adjustment-assuming they are supported, assessed/managed, and submitted per program requirements. In contrast, certain facility claim types do not typically contribute to CMS-HCC capture in the same way. Hospice care is generally treated as a carve-out/unique payment environment and is not relied upon as a routine source of risk-adjusting diagnosis capture for the member's ongoing RAF. Renal dialysis centers (ESRD facilities) likewise operate under specialized payment constructs and are not the typical outpatient setting used to drive CMS-HCC diagnosis capture for risk adjustment in standard CDI workflows. Freestanding ambulatory surgical centers also frequently fall outside the usual risk-adjustment-eligible encounter sources emphasized in outpatient CDI programs. Therefore, the hospital ambulatory clinic is the correct setting among these choices.
問題 #110
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VCESoft 的 CCDS-O 擬真試題覆蓋了真實的 ACDIS 考試指南，並根據其編定適合全球考生都能通用的題庫，讓每一位考生都能順利通過考試。IT人員想要在業內有所成就，選對IT認證是關鍵，雖然獲取認證需要投入額外的時間與金錢，但事實證明IT認證的投入產出是值得的，對於未來的職業發展非常有利。據業內人士介紹，CCDS-O 公司推出的 ACDIS 考題發生了變化，請各位 ACDIS 的 CCDS-O 考生注意一下，不過也不必太著急。
CCDS-O熱門考古題: https://www.vcesoft.com/CCDS-O-pdf.html
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