CRC FINAL EXAM | COMPLETE QUESTIONS WITH EXPERT
SOLUTION | 2026 LATEST UPDATED GET A+
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)
Prescription based program risk adjustment examples(Dxcg) - (Answer)RxGroups(DxCG)
Prescription based program risk adjustment examples(HCC-D) - (Answer)Hierarchical Condition
Category, Part D(HCC-D
Trump List - (Answer)Families or hierarchies set a value base on severity of illness with more
severe diagnoses carrying the overall risk score for that family.
Stage 1 Pressure Ulcer - (Answer)Persistent focal erythema
stage 2 pressure ulcer - (Answer)Partial thickness skin loss involving epidermis, dermis, or both
Stage 3 pressure ulcer - (Answer)Full Thickness skin loss extending through subcutaneous tissue
Stage 4 Pressure ulcer - (Answer)Necrosis of soft tissue extending to muscle and bone
Unstageable Ulce - (Answer)is covered in eschar or slough it cannot be determine how deep
Pathologic Fractures - (Answer)Broken bone that occures in an area of weakened bone. The
cause typically due to another disease such as neoplasm or osteoporosis
Stress Fractures - (Answer)repeated force or overuse. these fractures are considered non-
traumatic
, malunion fracture - (Answer)a healed fracture in a undesirable position resulting in a deformity
or crooked limb.
nonunion fracture - (Answer)fracture is not healing New bone tissure is not growing to bridge
the gap between the broken bones
FFS Normalization adjustment - (Answer)CMS payments are based on a population with an
average risk score
Special population for normalization factores - (Answer)Pace Mode, ESRD and Part D
History of CDPS - (Answer)Began using RA in 1996 utilizing claims from disabled beneficiaries
information from the disability payment system from Colorado, Michiganm Missouri, New York,
and Ohio
Star Ratings - (Answer)Medicare Advantage plan would received a bonus if they receive 4 or
more stars in 5 star quality ratings
5 star - (Answer)Excellent performance
4 star - (Answer)Above Average Performance
3 star - (Answer)average performance
2 star - (Answer)Below average performance
1 star - (Answer)Poor Performance
SOLUTION | 2026 LATEST UPDATED GET A+
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)
Prescription based program risk adjustment examples(Dxcg) - (Answer)RxGroups(DxCG)
Prescription based program risk adjustment examples(HCC-D) - (Answer)Hierarchical Condition
Category, Part D(HCC-D
Trump List - (Answer)Families or hierarchies set a value base on severity of illness with more
severe diagnoses carrying the overall risk score for that family.
Stage 1 Pressure Ulcer - (Answer)Persistent focal erythema
stage 2 pressure ulcer - (Answer)Partial thickness skin loss involving epidermis, dermis, or both
Stage 3 pressure ulcer - (Answer)Full Thickness skin loss extending through subcutaneous tissue
Stage 4 Pressure ulcer - (Answer)Necrosis of soft tissue extending to muscle and bone
Unstageable Ulce - (Answer)is covered in eschar or slough it cannot be determine how deep
Pathologic Fractures - (Answer)Broken bone that occures in an area of weakened bone. The
cause typically due to another disease such as neoplasm or osteoporosis
Stress Fractures - (Answer)repeated force or overuse. these fractures are considered non-
traumatic
, malunion fracture - (Answer)a healed fracture in a undesirable position resulting in a deformity
or crooked limb.
nonunion fracture - (Answer)fracture is not healing New bone tissure is not growing to bridge
the gap between the broken bones
FFS Normalization adjustment - (Answer)CMS payments are based on a population with an
average risk score
Special population for normalization factores - (Answer)Pace Mode, ESRD and Part D
History of CDPS - (Answer)Began using RA in 1996 utilizing claims from disabled beneficiaries
information from the disability payment system from Colorado, Michiganm Missouri, New York,
and Ohio
Star Ratings - (Answer)Medicare Advantage plan would received a bonus if they receive 4 or
more stars in 5 star quality ratings
5 star - (Answer)Excellent performance
4 star - (Answer)Above Average Performance
3 star - (Answer)average performance
2 star - (Answer)Below average performance
1 star - (Answer)Poor Performance
