HCC Coding / Risk Adjustment Exam Prep –
Latest Update 2026 | Graded A+
Risk Adjustment Model - correct answerCalculates risk scores for all beneficiaries with
available data
What are the three submission deadlines? - correct answer1. First Friday in September
= Initial Risk Score
2. First Friday in March = Mid-year Update
3. January 31 after the payment year = Final reconcilation
Medicare risk adjustment model is prospective. This means? - correct answerDiagnoses
reported in the prior year and demographic information are utilized to "predict" future
costs and adjust payments accordingly
Risk Scores. - correct answerMeasures individual beneficiaries' relative risk and are
used to adjust payments for each beneficiary's expected expenditures.
FERAS Response Report. - correct answerRejected data after it has been processed
through FERAS is recorded in this report.
RAPS Return File - correct answerThis is a daily report that shows all records approved
and where errors occurred.
RAPS Transaction Error Report - correct answerDisplays records on which errors
occurred.
RAPS Transaction Summary Report - correct answerA report sent to the MA
organization daily and identifies data that have been finalized in RAPS database
Duplicate Diagnosis Cluster Report - correct answerShows diagnosis clusters submitted
with information that duplicates a stored cluster.
RAPS Monthly Plan Activity Report and Cumulative Plan Activity Report - correct
answerProvides a summary of all diagnoses stored for a given time period.
Error Frequency Report - correct answerThis report is distributed monthly and quarterly.
Provides an overview of all errors associated with files submitted in test and production.
RAPS database - correct answerStores all finalized diagnosis clusters
, Risk Adjustment System (RAS) - correct answerExecutes the risk adjustment model
and calculates the risk score using the SAS model.
Medicare Advantage Prescription Drug System (MARx) - correct answerProcesses
payments to plans and issues the MMR (Monthly Membership Report) and MOR (Model
Output Report).
How often does CMS conduct data validation audits and for what purpose? - correct
answerAudits are done annually on selected plans that may have to request medical
record documentation from the providers to support the submitted diagnoses.
What types of data are checked in FERAS? - correct answerFile-level, batch-level and
first and last detailed records
RAPS Return file - correct answerDaily reports that shows all records approved and
where errors occurred.
What does File-level information identified? - correct answerSubmitter
What does Batch-level information identify? - correct answerMA organization
What does Detail-level information identify? - correct answerBeneficiary
Define Reconciliation - correct answerThe completion of the implementation of
payments with CMS calculating final risk adjustment factors and beneficiary stats based
on complete data. Necessary adjustments for institutional status and demographic data
for enrollees is considered.
CMS continues to allow a period (approximately 13 months after the data collection
year) for submitting final RAPS data for the appropriate data collection period.
Is this condition a Probably Forever/Almost ALLS (still has condition even though
mediation or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
Septicemia (Category 380) - correct answerProbably Forever/Almost ALLS
Is this condition a Probably Forever/Almost ALLS (still has condition even though
mediation or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
Heart Failure (Category 428) - correct answerProbably Forever/Almost ALLS
Is this condition a Probably Forever/Almost ALLS (still has condition even though
mediation or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
Latest Update 2026 | Graded A+
Risk Adjustment Model - correct answerCalculates risk scores for all beneficiaries with
available data
What are the three submission deadlines? - correct answer1. First Friday in September
= Initial Risk Score
2. First Friday in March = Mid-year Update
3. January 31 after the payment year = Final reconcilation
Medicare risk adjustment model is prospective. This means? - correct answerDiagnoses
reported in the prior year and demographic information are utilized to "predict" future
costs and adjust payments accordingly
Risk Scores. - correct answerMeasures individual beneficiaries' relative risk and are
used to adjust payments for each beneficiary's expected expenditures.
FERAS Response Report. - correct answerRejected data after it has been processed
through FERAS is recorded in this report.
RAPS Return File - correct answerThis is a daily report that shows all records approved
and where errors occurred.
RAPS Transaction Error Report - correct answerDisplays records on which errors
occurred.
RAPS Transaction Summary Report - correct answerA report sent to the MA
organization daily and identifies data that have been finalized in RAPS database
Duplicate Diagnosis Cluster Report - correct answerShows diagnosis clusters submitted
with information that duplicates a stored cluster.
RAPS Monthly Plan Activity Report and Cumulative Plan Activity Report - correct
answerProvides a summary of all diagnoses stored for a given time period.
Error Frequency Report - correct answerThis report is distributed monthly and quarterly.
Provides an overview of all errors associated with files submitted in test and production.
RAPS database - correct answerStores all finalized diagnosis clusters
, Risk Adjustment System (RAS) - correct answerExecutes the risk adjustment model
and calculates the risk score using the SAS model.
Medicare Advantage Prescription Drug System (MARx) - correct answerProcesses
payments to plans and issues the MMR (Monthly Membership Report) and MOR (Model
Output Report).
How often does CMS conduct data validation audits and for what purpose? - correct
answerAudits are done annually on selected plans that may have to request medical
record documentation from the providers to support the submitted diagnoses.
What types of data are checked in FERAS? - correct answerFile-level, batch-level and
first and last detailed records
RAPS Return file - correct answerDaily reports that shows all records approved and
where errors occurred.
What does File-level information identified? - correct answerSubmitter
What does Batch-level information identify? - correct answerMA organization
What does Detail-level information identify? - correct answerBeneficiary
Define Reconciliation - correct answerThe completion of the implementation of
payments with CMS calculating final risk adjustment factors and beneficiary stats based
on complete data. Necessary adjustments for institutional status and demographic data
for enrollees is considered.
CMS continues to allow a period (approximately 13 months after the data collection
year) for submitting final RAPS data for the appropriate data collection period.
Is this condition a Probably Forever/Almost ALLS (still has condition even though
mediation or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
Septicemia (Category 380) - correct answerProbably Forever/Almost ALLS
Is this condition a Probably Forever/Almost ALLS (still has condition even though
mediation or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
Heart Failure (Category 428) - correct answerProbably Forever/Almost ALLS
Is this condition a Probably Forever/Almost ALLS (still has condition even though
mediation or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
