Free ACDIS CCDS-O Practice Exam with Questions & Answers | Set: 5

In MSSP-style ACO financial reconciliation, performance is evaluated against a benchmark (expected costs). Here, the ACO’s actual spending ($52M) exceeds the expected benchmark ($50M) by $2M, meaning the ACO generatedshared lossesrather than savings. In risk-bearing ACO arrangements, when costs exceed the benchmark and the ACO is in a track that includes downside risk, the organization may owe CMS a portion of those losses. The shared savings/loss rate (50% in this scenario) represents the percentage of the difference from the benchmark that the ACO shares with CMS, assuming applicable thresholds are met. Thus, instead of receiving a shared savings payment, the ACO would be accountable topay backa share of the excess spending (conceptually 50% of the $2M overage, if all model requirements are satisfied). Option D is not correct because reconciliation is typically performed on a performance-year basis rather than only at the end of the full agreement period, and option C is not how MSSP eligibility works.

The best query is chronic respiratory failure because home oxygen is a strong clinical indicator that often reflects an underlying chronic hypoxemic condition beyond uncomplicated COPD. Outpatient CDI guidance stresses that queries should be driven by present clinical indicators in the note and should seek clarification that impacts accurate diagnosis capture and ongoing care. Here, the provider documents COPD plus home oxygen and is arranging continued services (medication management and home health), which supports asking whether the patient has a reportable condition such as chronic respiratory failure with hypoxia (or COPD with chronic hypoxemia) and whether it is being monitored/managed. The other options lack support: acute blood loss anemia has no bleeding, hemodynamic instability, or acute findings; peripheral neuropathy is not assessed or described despite diabetes; and CKD has no labs, staging, history, or assessment. A compliant query would be non-leading and include the indicator (home O₂) and request the most accurate diagnosis and specificity/status.