CRC EXAM 2025/2026 EXAM
QUESTIONS AND ANSWERS | 100%
PASS
Risk Adjustment Data Element - 🧠 ANSWER ✔✔Age, Gende,
Socioeconomic status, Disability status, Insurance status(Medicaid, dual-
eligible,) Claims data elements such as procedure codes, place of service
codes, special patient-specific conditions hospice, ESRD
RAF - 🧠 ANSWER ✔✔Risk Adjustment Factor Scores
Three main types of reviews - 🧠 ANSWER ✔✔Retrospective, Concurrent
and prospective
Retrospective - 🧠 ANSWER ✔✔reviews are performed after the information
has been reported and in risk adjustment these are prior years dos
, Concurrent reviews - 🧠 ANSWER ✔✔performed ongoing as patients are
seen prior to reporting and in risk adjustment the current year
Prospective reviews - 🧠 ANSWER ✔✔will effect the next year and not the
current year where payment is concerned. They are used to forcast
Types of Risk Adjustment Models(HHS) - 🧠 ANSWER ✔✔HHS hEALTH
AND HUMAN SERVICES hIERARCHICAL CONDITION(Commercial,
individual and small grooup
Types of Risk Adjustment Modles(CDPS) - 🧠 ANSWER ✔✔Chronic Illness
and Disability payment systems(Medicaid)
Types of Risk Adjustment Models(HCC-C) - 🧠 ANSWER ✔✔Hierarchical
Condition Category, Part C
Types of Risk Adjustment model (DRG) - 🧠 ANSWER ✔✔Diagnosis
Related Group (Inpatient)
Types of Risk Adjustment model (ACG) - 🧠 ANSWER ✔✔Adjusted Clinical
Groups(Outpatient)
Prescription based program risk adjustment examples:UCSD - 🧠 ANSWER
✔✔Medicaid Rx(UCSD)
QUESTIONS AND ANSWERS | 100%
PASS
Risk Adjustment Data Element - 🧠 ANSWER ✔✔Age, Gende,
Socioeconomic status, Disability status, Insurance status(Medicaid, dual-
eligible,) Claims data elements such as procedure codes, place of service
codes, special patient-specific conditions hospice, ESRD
RAF - 🧠 ANSWER ✔✔Risk Adjustment Factor Scores
Three main types of reviews - 🧠 ANSWER ✔✔Retrospective, Concurrent
and prospective
Retrospective - 🧠 ANSWER ✔✔reviews are performed after the information
has been reported and in risk adjustment these are prior years dos
, Concurrent reviews - 🧠 ANSWER ✔✔performed ongoing as patients are
seen prior to reporting and in risk adjustment the current year
Prospective reviews - 🧠 ANSWER ✔✔will effect the next year and not the
current year where payment is concerned. They are used to forcast
Types of Risk Adjustment Models(HHS) - 🧠 ANSWER ✔✔HHS hEALTH
AND HUMAN SERVICES hIERARCHICAL CONDITION(Commercial,
individual and small grooup
Types of Risk Adjustment Modles(CDPS) - 🧠 ANSWER ✔✔Chronic Illness
and Disability payment systems(Medicaid)
Types of Risk Adjustment Models(HCC-C) - 🧠 ANSWER ✔✔Hierarchical
Condition Category, Part C
Types of Risk Adjustment model (DRG) - 🧠 ANSWER ✔✔Diagnosis
Related Group (Inpatient)
Types of Risk Adjustment model (ACG) - 🧠 ANSWER ✔✔Adjusted Clinical
Groups(Outpatient)
Prescription based program risk adjustment examples:UCSD - 🧠 ANSWER
✔✔Medicaid Rx(UCSD)
