CDI
This professional association is considered the leading organization for CDI Specialists.
What is a ACDIS query?
This coding system is used to report diagnoses in the inpatient and outpatient setting.
What is ICD-10-CM?
This professional association is considered the leading organization for Revenue Integrity professionals.
What is NAHRI?
When a payer reimburses less than the contracted amount, it is called this.
What is an underpayment?
This federal law establishes national standards for protecting patient health information.
What is HIPAA?
These two quality metrics are improved when documentation accurately reflects patient acuity.
What are Severity of Illness (SOI) and Risk of Mortality (ROM)?
These codes are used to describe services, procedures, and professional services performed?
What are CPT® codes?
This process verifies that all services performed have been appropriately documented, charged, and billed.
What is charge capture?
This process compares expected reimbursement to actual reimbursement received from a payer.
What is payment variance analysis?
This professional association is considered the leading organization for Health Information Management professionals.
What is AHIMA?
CDI and Coding Teams collaborate to improve this metric, which reflects the complexity and resource intensity of the patients treated.
What is Case Mix Index (CMI)?
Assigning codes not supported by provider documentation is known as this compliance risk.
What is upcoding?
The process of ensuring that every documented service has an appropriate charge associated with it.
What is charge reconciliation?
Payment Integrity teams often use these documents to validate expected reimbursement amounts.
What are payer contracts?
This step ensures scanned documents are assigned to the correct patient record.
What is indexing?
CDI may issue this type of query when a documented diagnosis is not supported by clinical indicators.
What is a clinical validation query?
This federal agency publishes the Official Coding Guidelines annually.
What is CMS (Centers for Medicare and Medicaid Services)?
One major purpose of Revenue Integrity is preventing overbilling and this opposite issue.
What is underbilling?
Recovering underpayments helps improve cash collections and this financial metric.
What is net revenue?
One of the most common documentation deficiencies occurs when a provider fails to complete this required veriication of a note or order.
What is a signature (authentication)?
True or False: CDI queries are intended to lead providers to a specific diagnosis.
What is False?
Pediatric malnutrition coding requires documentation of this key severity component.
What is the degree of malnutrition?
A procedure was documented and coded correctly but was never charged. Revenue Integrity would classify this as what?
What is revenue leakage?
A payer's refusal to reimburse a submitted claim is called this.
What is a denial?
This acronym refers to the database used to uniquely identify patients across an organization.
What is the Master Patient Index (MPI)?