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Exam (elaborations)

CDEO Exam Prep Practice Questions and Answers

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CDEO Exam Prep Practice Questions and Answers c. To facilitate optimum patient care The central focus of all clinical documentation should be to demonstrate the quality of care provided to the patient with detail and accuracy to facilitate optimum patient care. - ANSWER-What is the central foc...

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  • November 3, 2024
  • 117
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
  • CDEO
  • CDEO
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KaylinHoffman
Copyright © KAYLIN 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH NOVEMBER, 2024




CDEO Exam Prep Practice Questions and

Answers


c. To facilitate optimum patient care


The central focus of all clinical documentation should be to demonstrate the quality of care provided to

the patient with detail and accuracy to facilitate optimum patient care. - ANSWER✔✔-What is the

central focus of clinical documentation?


a. Protection against mal-practice claims


b. Communication to office staff and other departments about the patient's care


c. To facilitate optimum patient care


d. Communication to other the providers and ancillary personnel concerning the patient encounter


d. No, CDEOs review records on a proactive basis to prevent documentation deficiencies


Clinical documentation improvement is a proactive measure. The CDS will develop and monitor policies

and procedures that affect the documentation process. CDI should begin at the front end of all services

and care. Prevention of documentation issues is the key. See Page 1 - ANSWER✔✔-The CDEO will focus

his or her attention on records requested for post payment review.


a. Yes, CDEOs only review records that might be an audit concern and require physician education.


b. Yes, CDEOs only review records for paid claims by government payers.


c. No, CDEOs do not review records unless it is requested by the compliance officier.


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d. No, CDEOs review records on a proactive basis to prevent documentation deficiencies


c. Prevent deficient documentation


The CDEO will review the findings of the auditor to determine what should be done to resolve

documentation the issues on a proactive basis to prevent documentation and compliance risks. -

ANSWER✔✔-The CDEO will review the findings of the auditor in order to:


a. Reprocess claims


b. Make an addendum to the medical record


c. Prevent deficient documentation


d. Know what accounts should be adjusted off


I, II, III, and IV


For different reasons other than reimbursement, requests for medical records come from different

sources, for a multitude of different reasons. A few of these, other than Federal Health Care Plans, are

patients who are becoming more active in their care , attorneys seeking information for third party

liability claims or mal-practice claims, other providers involved in the patients' care, employers for pre-

employment applications and worker's compensation cases, private payers, recruiting offices for military

applications, and the social security administration for the patients' SSI applications. - ANSWER✔✔-

Which of the following sources other than federal healthcare plans may request the medical records?


I. Patients


II. Providers involved with the patient's care


III. Employers for worker's compensation claims



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IV. Private payers


a. The appropriateness of the services provided


In addition to facilitating high quality patient care, a properly documented medical record verifies and

documents precisely what services were actually provided. The medical record may be used to validate:

(a) The site of the service; (b) The appropriateness of the services provided; (c) The accuracy of the

billing; and (d) The identity of the caregiver. - ANSWER✔✔-In addition to facilitating high quality patient

care, a properly documented medical record verifies and documents precisely what services were

actually provided. Other than the site of service the medical record may be used to validate:


a. The appropriateness of the services provided


b. The patient's certificate of birth


c. The identity of the patient's extended family


d. The cost of healthcare benefits used for the year.


c. Detailed, well documented notes


The details in a well-documented note are a provider's best defense in any legal situation. If the record is

deficient in details, there is no "evidence" to support a provider's testimony. - ANSWER✔✔-A provider's

best defense in any legal situation is:


a. Patient records maintained for five years


b. An experienced healthcare attorney


c. Detailed, well documented notes


d. Updated computer storage systems



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c. During the encounter or as soon as possible


The best way to achieve the most accurate, detailed documentation is for the provider to document the

encounter/services as soon as possible after (if not during) the encounter. - ANSWER✔✔-To maintain an

accurate medical record, what is the recommended appropriate time for provider documentation?


a. Within 48 hours of patient visit


b. A minimum of bi-weekly


c. During the encounter or as soon as possible


d. The end of each day for all encounters that day


d. If it is documented in the patient's medical record


Quality assurance in patient care is only evident if it is documented in the medical record. Quality

services may have been provided; however, if this is not evident within the medical record, problems

may arise. - ANSWER✔✔-Quality assurance of patient care is only evident if:


a. The patient maintains a state of optimum health


b. Visits are only required for well-checks or injury


c. The patient survey and ROS does not change


d. If it is documented in the patient's medical record


b. Documentation reviews can be performed on a prospective basis.


CDI programs are intended to be performed on a prospective basis to improve documentation

deficiencies prior to claim submission. The intent is to identify deficiencies and make the appropriate

corrections and prevent future deficiencies. CDI programs can also include retrospective reviews. -


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