AAPC CRC ACTUAL PRACTICE TEST COMBINED DIFFERENT VERSION A,B,C
NEWEST VERSION 2026-2027 ACTUAL EXAM COMPLETE VERSION EACH 50
TOTAL (150) QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) |ALREADY GRADED A+.
VERSION A
QUESTION
Which one of the following would prevent a chart from being coded for
Medicare risk adjustment?
A. Patient's DOB is not documented on the medical record
B. The patient presented for an acute condition
C. Medical record does not include the credentials of the treating provider
D. Date of service is past 90 days
Correct Answer: C
Expert Rationale
A medical record that does not include the credentials of the treating
provider (Option C) would prevent a chart from being coded for Medicare
risk adjustment. For a diagnosis to be valid for risk adjustment, the medical
record must clearly identify the provider who rendered the service and
documented the diagnosis. The provider's credentials (MD, DO, NP, PA) must
be evident to establish that the diagnosis was made by an approved provider
type. While the patient's DOB (Option A) is important for patient
identification, its absence would not necessarily prevent coding for risk
adjustment if other patient identifiers are present. The presentation for an
acute condition (Option B) does not prevent coding; acute conditions can be
coded when documented. The date of service being past 90 days (Option D)
does not prevent coding, as risk adjustment encompasses services from the
entire calendar year.
,DIF: Cognitive Level: Understand (Comprehension)
TOP: Risk Adjustment - Medical Record Requirements
MSC: Medicare Risk Adjustment
QUESTION
Which diagnoses can be coded from a medical record that states a member
has the condition, but does not contain supporting documentation?
I. COPD
II. Croup
III. A-Fib
IV. GERD
V. Parkinson's disease
VI. MS
A. I and II
B. III, IV, V and VI
C. II, V and VI
D. I, III, V, and VI
Correct Answer: D
Expert Rationale
Certain diagnoses are considered "chronic" or "irreversible" conditions that
require supporting documentation in the medical record, even if the
condition is simply stated. For conditions such as COPD (I), A-Fib (III),
Parkinson's disease (V), and MS (VI), the diagnosis is generally considered to
be ongoing and does not require extensive supportive documentation for
risk adjustment coding, provided the provider has documented the condition
in the assessment or plan. However, conditions like Croup (II) and GERD (IV)
are acute or less specific conditions that typically require more detailed
supporting documentation to validate the diagnosis. The correct answer is D
,(I, III, V, and VI), as these conditions can be coded when stated without
extensive additional documentation.
DIF: Cognitive Level: Analyze (Analysis)
TOP: Risk Adjustment - Diagnosis Documentation Requirements
MSC: Medicare Risk Adjustment
RADV/IVA AUDIT REQUIREMENTS
QUESTION
RADV/IVA audit submissions typically require:
I. Provider printed name
II. Two patient identifiers
III. Provider's signature
IV. Must include specialist consultations
V. Must include coordination of care documentation by clinical staff
A. II and III
B. I, II and IV
C. I, III, IV, and V
D. I, II, III, IV, and V
Correct Answer: A
Expert Rationale
RADV (Risk Adjustment Data Validation) and IVA (Independent Validation of
Audits) audit submissions typically require two patient identifiers (II) and the
provider's signature (III). Two patient identifiers, such as the patient's name
and date of birth or medical record number, are essential for confirming that
the medical record belongs to the correct beneficiary. The provider's
signature is required to authenticate the documentation and confirm that
the provider personally rendered the service and documented the
diagnoses. The provider's printed name (I) may be required on some forms
, but is not always a specific requirement for the medical record submission
itself. Specialist consultations (IV) and coordination of care documentation
(V) are not mandatory elements for RADV submissions, though they may
strengthen the documentation if present. The audit primarily requires the
medical record that supports the diagnosis being validated, with clear
patient identification and provider authentication.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Audits - RADV/IVA Submission Requirements
MSC: Medicare Risk Adjustment
RETROSPECTIVE AUDITS
QUESTION
Which statements are TRUE regarding retrospective audits?
I. Can be performed by internal employees
II. Can be performed by external consultants who sign a business agreement
III. Performed prior to data being submitted
IV. Performed after data was submitted
A. I and III
B. I and IV
C. I, II, and IV
D. III and IV
Correct Answer: C
Expert Rationale
Retrospective audits can be performed by internal employees (I), external
consultants who sign a business agreement (II), and are performed after data
was submitted (IV). Retrospective audits occur after claims data has been
submitted to CMS, allowing health plans to review and validate the accuracy
of submitted diagnoses. These audits provide opportunities to identify
NEWEST VERSION 2026-2027 ACTUAL EXAM COMPLETE VERSION EACH 50
TOTAL (150) QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) |ALREADY GRADED A+.
VERSION A
QUESTION
Which one of the following would prevent a chart from being coded for
Medicare risk adjustment?
A. Patient's DOB is not documented on the medical record
B. The patient presented for an acute condition
C. Medical record does not include the credentials of the treating provider
D. Date of service is past 90 days
Correct Answer: C
Expert Rationale
A medical record that does not include the credentials of the treating
provider (Option C) would prevent a chart from being coded for Medicare
risk adjustment. For a diagnosis to be valid for risk adjustment, the medical
record must clearly identify the provider who rendered the service and
documented the diagnosis. The provider's credentials (MD, DO, NP, PA) must
be evident to establish that the diagnosis was made by an approved provider
type. While the patient's DOB (Option A) is important for patient
identification, its absence would not necessarily prevent coding for risk
adjustment if other patient identifiers are present. The presentation for an
acute condition (Option B) does not prevent coding; acute conditions can be
coded when documented. The date of service being past 90 days (Option D)
does not prevent coding, as risk adjustment encompasses services from the
entire calendar year.
,DIF: Cognitive Level: Understand (Comprehension)
TOP: Risk Adjustment - Medical Record Requirements
MSC: Medicare Risk Adjustment
QUESTION
Which diagnoses can be coded from a medical record that states a member
has the condition, but does not contain supporting documentation?
I. COPD
II. Croup
III. A-Fib
IV. GERD
V. Parkinson's disease
VI. MS
A. I and II
B. III, IV, V and VI
C. II, V and VI
D. I, III, V, and VI
Correct Answer: D
Expert Rationale
Certain diagnoses are considered "chronic" or "irreversible" conditions that
require supporting documentation in the medical record, even if the
condition is simply stated. For conditions such as COPD (I), A-Fib (III),
Parkinson's disease (V), and MS (VI), the diagnosis is generally considered to
be ongoing and does not require extensive supportive documentation for
risk adjustment coding, provided the provider has documented the condition
in the assessment or plan. However, conditions like Croup (II) and GERD (IV)
are acute or less specific conditions that typically require more detailed
supporting documentation to validate the diagnosis. The correct answer is D
,(I, III, V, and VI), as these conditions can be coded when stated without
extensive additional documentation.
DIF: Cognitive Level: Analyze (Analysis)
TOP: Risk Adjustment - Diagnosis Documentation Requirements
MSC: Medicare Risk Adjustment
RADV/IVA AUDIT REQUIREMENTS
QUESTION
RADV/IVA audit submissions typically require:
I. Provider printed name
II. Two patient identifiers
III. Provider's signature
IV. Must include specialist consultations
V. Must include coordination of care documentation by clinical staff
A. II and III
B. I, II and IV
C. I, III, IV, and V
D. I, II, III, IV, and V
Correct Answer: A
Expert Rationale
RADV (Risk Adjustment Data Validation) and IVA (Independent Validation of
Audits) audit submissions typically require two patient identifiers (II) and the
provider's signature (III). Two patient identifiers, such as the patient's name
and date of birth or medical record number, are essential for confirming that
the medical record belongs to the correct beneficiary. The provider's
signature is required to authenticate the documentation and confirm that
the provider personally rendered the service and documented the
diagnoses. The provider's printed name (I) may be required on some forms
, but is not always a specific requirement for the medical record submission
itself. Specialist consultations (IV) and coordination of care documentation
(V) are not mandatory elements for RADV submissions, though they may
strengthen the documentation if present. The audit primarily requires the
medical record that supports the diagnosis being validated, with clear
patient identification and provider authentication.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Audits - RADV/IVA Submission Requirements
MSC: Medicare Risk Adjustment
RETROSPECTIVE AUDITS
QUESTION
Which statements are TRUE regarding retrospective audits?
I. Can be performed by internal employees
II. Can be performed by external consultants who sign a business agreement
III. Performed prior to data being submitted
IV. Performed after data was submitted
A. I and III
B. I and IV
C. I, II, and IV
D. III and IV
Correct Answer: C
Expert Rationale
Retrospective audits can be performed by internal employees (I), external
consultants who sign a business agreement (II), and are performed after data
was submitted (IV). Retrospective audits occur after claims data has been
submitted to CMS, allowing health plans to review and validate the accuracy
of submitted diagnoses. These audits provide opportunities to identify
