Risk Adjustment CRC Exam Questions
2025/2026 Exam All Answers and
Illustrations Given
Interactions - 🧠 ANSWER ✔✔What are extra RA values or factors added
when a patient has more than one major significant dx identified in model ?
Quality, Promoting Interoperability, Improvement Activity, Cost - 🧠
ANSWER ✔✔MIPS Collection Types Categories
When are Star Ratings publicly published? - 🧠 ANSWER ✔✔October of
each year
HEDIS types of collection - 🧠 ANSWER ✔✔Surveys, Medical Chart
Reviews, Insurance Claims, Medical Office Visits, Procedures
,What does Abbreviation MAC stand for? - 🧠 ANSWER ✔✔Medicare
Administrative Contractor
Each year, Medicare normalizes risk scores to maintain an average of
what? - 🧠 ANSWER ✔✔1.0
Which type of documentation can be used to support diagnoses reported
under risk adjustment models? - 🧠 ANSWER ✔✔Inpatient admission note
Risk adjustment models are used to: - 🧠 ANSWER ✔✔Determine projected
costs of health care based on the condition(s) of patients
When submitting records for RADV audit, will additional current diagnoses
that were not originally reported be considered when documentation is
submitted for the audit? - 🧠 ANSWER ✔✔Yes, additional current diagnoses
not included on claims data may be approved during the audit.
For commercial plans, funding is allocated based on - 🧠 ANSWER
✔✔Current year's known diagnoses
What is the impact on reimbursement under the risk adjustment model if
chronic conditions are not coded properly? - 🧠 ANSWER ✔✔Failure to code
for a chronic condition the patient has may result in an inaccurate RAF.
, What is the purpose of a RADV - 🧠 ANSWER ✔✔To evaluate the
appropriateness of risk scores to patients.
How many records are submitted by health plans per patient in a RADV
audit? - 🧠 ANSWER ✔✔5
Each record submitted for a RADV should include: - 🧠 ANSWER ✔✔I.
Complete list and legible records
2. Credential for the rendering provider
3.Provider signature or attestation
How is predictive modeling used in risk adjustment? - 🧠 ANSWER
✔✔Determine suspected diagnoses based on data elements.
What might happen as a result of predictive modeling? - 🧠 ANSWER
✔✔Disease Management Programs
In the CMS Star Ratings program, which measure is given the highest
weight? - 🧠 ANSWER ✔✔Outcomes
The results of a RADV audit are extrapolated across all members of the
plan that was audited. What does this mean? - 🧠 ANSWER ✔✔Financial
penalties will be averaged over the plan membership
COPYRIGHT©NINJANERD 2025/2026. YEAR PUBLISHED 2025. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE. PRIVACY
STATEMENT. ALL RIGHTS RESERVED
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2025/2026 Exam All Answers and
Illustrations Given
Interactions - 🧠 ANSWER ✔✔What are extra RA values or factors added
when a patient has more than one major significant dx identified in model ?
Quality, Promoting Interoperability, Improvement Activity, Cost - 🧠
ANSWER ✔✔MIPS Collection Types Categories
When are Star Ratings publicly published? - 🧠 ANSWER ✔✔October of
each year
HEDIS types of collection - 🧠 ANSWER ✔✔Surveys, Medical Chart
Reviews, Insurance Claims, Medical Office Visits, Procedures
,What does Abbreviation MAC stand for? - 🧠 ANSWER ✔✔Medicare
Administrative Contractor
Each year, Medicare normalizes risk scores to maintain an average of
what? - 🧠 ANSWER ✔✔1.0
Which type of documentation can be used to support diagnoses reported
under risk adjustment models? - 🧠 ANSWER ✔✔Inpatient admission note
Risk adjustment models are used to: - 🧠 ANSWER ✔✔Determine projected
costs of health care based on the condition(s) of patients
When submitting records for RADV audit, will additional current diagnoses
that were not originally reported be considered when documentation is
submitted for the audit? - 🧠 ANSWER ✔✔Yes, additional current diagnoses
not included on claims data may be approved during the audit.
For commercial plans, funding is allocated based on - 🧠 ANSWER
✔✔Current year's known diagnoses
What is the impact on reimbursement under the risk adjustment model if
chronic conditions are not coded properly? - 🧠 ANSWER ✔✔Failure to code
for a chronic condition the patient has may result in an inaccurate RAF.
, What is the purpose of a RADV - 🧠 ANSWER ✔✔To evaluate the
appropriateness of risk scores to patients.
How many records are submitted by health plans per patient in a RADV
audit? - 🧠 ANSWER ✔✔5
Each record submitted for a RADV should include: - 🧠 ANSWER ✔✔I.
Complete list and legible records
2. Credential for the rendering provider
3.Provider signature or attestation
How is predictive modeling used in risk adjustment? - 🧠 ANSWER
✔✔Determine suspected diagnoses based on data elements.
What might happen as a result of predictive modeling? - 🧠 ANSWER
✔✔Disease Management Programs
In the CMS Star Ratings program, which measure is given the highest
weight? - 🧠 ANSWER ✔✔Outcomes
The results of a RADV audit are extrapolated across all members of the
plan that was audited. What does this mean? - 🧠 ANSWER ✔✔Financial
penalties will be averaged over the plan membership
COPYRIGHT©NINJANERD 2025/2026. YEAR PUBLISHED 2025. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE. PRIVACY
STATEMENT. ALL RIGHTS RESERVED
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