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NEW QUESTION # 102
Which of the following conditions is commonly treated with the medication sertraline?
Answer: D
Explanation:
Sertraline is a selective serotonin reuptake inhibitor (SSRI) most commonly used to treat depressive disorders and several anxiety-related conditions. In outpatient chart review, recognizing medication-condition relationships supports accurate problem list maintenance and compliant diagnosis reporting, but the diagnosis must still be clearly documented as assessed/managed at the encounter. Depression is the best match because SSRIs like sertraline are first-line pharmacologic therapy for major depressive disorder and are frequently continued long-term with monitoring for symptom control, side effects, and functional status. Schizophrenia is primarily treated with antipsychotic medications; sertraline may be used only as an adjunct if a comorbid depressive or anxiety disorder is present, so it is not the common primary treatment. Asthma management centers on bronchodilators and inhaled corticosteroids, not SSRIs. Heart failure therapy involves guideline-directed cardiac medications (e.g., beta-blockers, ACE inhibitors/ARNI, diuretics), and sertraline is not a standard heart failure treatment. Outpatient CDI education emphasizes documenting the specific mental health diagnosis, current status (stable/worsening), and treatment plan to support coding.
NEW QUESTION # 103
Which of the following is designed to reduce claims denials and appeals by providing one-on-one feedback to the provider to increase accuracy in specific areas?
Answer: B
Explanation:
Targeted Probe and Educate (TPE) is an education-focused review initiative intended to improve billing accuracy and reduce future denials by combining targeted claim review with direct provider/supplier feedback. In outpatient CDI terms, TPE aligns with a "fix-forward" approach: auditors identify specific error patterns (often documentation, medical necessity, coding, or coverage rule issues), then provide one-on-one education so the provider can correct processes and documentation habits. This is distinct from Recovery Audit Contractors (RACs), which primarily identify and recoup improper payments, often after the fact, and are not structured as an individualized education cycle. The OIG Work Plan identifies oversight priorities and areas of potential fraud/waste/abuse; it does not deliver provider-level coaching to reduce denials. CERT measures Medicare improper payment rates through sampling and can drive policy/education broadly, but it is not designed as individualized, iterative provider education. Because TPE is specifically built around targeted review plus direct education to prevent repeat errors and reduce appeals, it is the best answer.
NEW QUESTION # 104
Which of the following conditions or findings supports a diagnosis of diabetes?
Answer: D
Explanation:
In outpatient clinical documentation and chart review, diabetes can be supported by recognized diagnostic thresholds. An HbA1c value reflects average blood glucose over approximately the prior 2-3 months and is commonly used to diagnose and monitor diabetes. An HbA1c ≥ 6.5% (when confirmed per clinical practice standards and interpreted in the appropriate clinical context) supports a diagnosis of diabetes; therefore an HbA1c of 7.0% clearly meets the threshold and supports diabetes. By comparison, a 2-hour OGTT value of 90 mg/dL is normal and does not support diabetes (diabetes is typically supported when the 2-hour value is ≥ 200 mg/dL). Hypoglycemia is low blood glucose and is not diagnostic of diabetes; it may occur in diabetics due to treatment but can also occur in non-diabetics for many reasons. A fasting glucose of 100 mg/dL is at most borderline/prediabetes range and does not meet diagnostic criteria for diabetes (diabetes is supported at ≥ 126 mg/dL).
NEW QUESTION # 105
A patient was recently admitted to the hospital for emphysema, end stage COPD, and heart failure. The patient was discharged on home oxygen. In preparation for the patient's upcoming PCP visit, the MOST important query opportunity for a CDI specialist is which of the following?
Answer: A
Explanation:
Home oxygen is a strong clinical indicator, but by itself it does not tell why the patient requires it. Outpatient CDI best practice prioritizes clarifying the clinical indication because it drives accurate, compliant diagnosis reporting and supports medical necessity and severity of illness. "Oxygen dependence" (a status concept) may be appropriate, but it is secondary and often incomplete without the underlying condition-such as chronic hypoxic respiratory failure, chronic respiratory failure with hypercapnia, or persistent hypoxemia related to end-stage COPD/emphysema. Clarifying the indication also helps ensure the provider documents objective support (e.g., qualifying O2 sats, ABG findings, exertional vs resting hypoxemia) and ties it to assessment/plan at the PCP visit. While specifying heart failure type (A) is valuable, and emphysema "status" (B) may be less actionable because emphysema is typically chronic and encompassed within COPD management, the oxygen requirement is the most immediate cue of higher acuity and a frequent documentation gap. Therefore, clarifying the indication for home oxygen is the highest-value query opportunity.
NEW QUESTION # 106
In a year over year comparison, the total number of patients with the more specific diagnosis of morbid obesity versus unspecified obesity increased from 10,000 patients to 11,000 patients. Which of the following is the hypothetical increase in yearly reserve for that patient population? (Morbid obesity HCC value = 0.186 and PMPM = $800.00)
Answer: B
Explanation:
This question applies the outpatient risk adjustment "reserve" concept: predicted cost is estimated by multiplying the member's risk factor contribution by a baseline per-member-per-month (PMPM) amount, then annualizing. The morbid obesity HCC factor is 0.186, and PMPM is $800. First compute the monthly cost impact: $800 × 0.186 = $148.80 per month per patient. Convert to yearly: $148.80 × 12 = $1,785.60 per patient per year. The year-over-year increase in patients with morbid obesity documentation is 11,000 - 10,000 = 1,000 additional patients. Multiply the annual per-patient impact by the additional patient count: $1,785.60 × 1,000 = $1,785,600. Outpatient CDI programs emphasize that improving documentation specificity (when clinically supported) can change whether an HCC is captured, which can affect RAF-based projections and resource planning. However, documentation must still be accurate, supported, and reflect conditions assessed/managed during the encounter.
NEW QUESTION # 107
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