CRC FINAL EXAM NEWEST 2024 ACTUAL EXAM
COMPLETE 250 QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS)
ALREADY GRADED A+.
How is predictive modeling used in risk adjustment? -
ANSWER >>>>to determine suspected diagnosis based on
data elements.
Which of the following data elements are used in predictive
modeling?
I. DME claims
II. Prescription drug events
III. Physician claims data
IV. Facility claims data
a. III and IV
b. I, II, and IV
c. I, II, and III
d. I, II, III, and IV - ANSWER >>>>d. I, II, III, and IV
What might happen as a result of predictive modeling?
a. Disease management programs
b. Concurrent audits
c. Transporation benefits
d. Reduction in case management - ANSWER >>>>a.
Disease management programs
In the CMS Star Ratings program, which measure is given the
highest weight?
a. Outcomes
,b. Patient experience
c. Customer service
d. Accurate RAF scores - ANSWER >>>>a. Outcomes
How often are HEDIS measures revised?
a. As needed
b. Monthly
c. Bi-annually
d. Annually - ANSWER >>>>d. Annually
Which statement is TRUE regarding the CMS Stars quality
rating system?
a. Quality bonus payments are made to physician who score
at least four stars.
b. Quality bonus payments are made to Medicare Advantage
plans who score at least four stars.
c. Quality bonus payments are made to physician who score
at least five stars.
d. Quality bonus payments are made to Medicare Advantage
plans who score at least five stars. - ANSWER >>>>b. Quality
bonus payments are made to Medicare Advantage plans who
score at least four stars.
Merit-based Incentive Payment System (MIPS) includes
which performance categories?
I. Promoting Interoperability
II. Cost
III. Improvement Activities
IV. Quantity
V. Quality
a. I and II
b. I, III, and V
,c. I, II, III, and V
d. I, II, III, IV, and V - ANSWER >>>>c. I, II, III, and V
Which of the following are domains in CMS Part C & D Stars
Rating?
I. Staying Healthy
II. Managing Chronic Conditions
III. Member Experience with Health Plans
IV. Member Complaints, Problems Getting Services, and
Improvement in the Health Plan's Performance
V. Health Plan Customer Service
a. I, II and III
b. I, III, and V
c. I, II, III, IV and V
d. I, II, III and V - ANSWER >>>>c. I, II, III, IV and V
What are the participation tracks available through Medicare
Access and CHIP Reauthorization Act (MACRA)?
I. Merit-based Incentive Payment Systems
II. Sustainable Growth System
III. Advanced Alternative Payment Models
a. I
b. II and III
c. I and III
d. I, II and III - ANSWER >>>>c. I and III
What is predictive modeling?
a. An analytical review of known data elements to establish a
hypothesis related to the future health of patients.
b. An analytical review of payments to health plans to
determine the cost of future healthcare.
, c. An average of costs associated with diagnoses used to
determine which providers to contract with for a health plan.
d. An average payment associated with diagnoses used to
determine which health plans providers should contract with. -
ANSWER >>>>a. An analytical review of known data
elements to establish a hypothesis related to the future health
of patients.
Who developed and maintains HEDIS?
a. CMS
b. OIG
c. BCBS
d. NCQA - ANSWER >>>>d. NCQA
What do the Star Ratings identify?
a. Top performing health plans based on quality
b. Top performing doctors based on quality
c. Cost of healthcare in facilities
d. Cost of healthcare by provider - ANSWER >>>>a. Top
performing health plans based on quality
What is the goal of HEDIS?
a. Allow for patients to rate their physicians.
b. Allow patients to compare health plans.
c. Allow patients to schedule appointments online.
d. Allow patients to access their medical records. - ANSWER
>>>>b. Allow patients to compare health plans.
When are Star Ratings are publicly published?
a. January of each year.
b. January and June of each year.
c. October of each year.
COMPLETE 250 QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS)
ALREADY GRADED A+.
How is predictive modeling used in risk adjustment? -
ANSWER >>>>to determine suspected diagnosis based on
data elements.
Which of the following data elements are used in predictive
modeling?
I. DME claims
II. Prescription drug events
III. Physician claims data
IV. Facility claims data
a. III and IV
b. I, II, and IV
c. I, II, and III
d. I, II, III, and IV - ANSWER >>>>d. I, II, III, and IV
What might happen as a result of predictive modeling?
a. Disease management programs
b. Concurrent audits
c. Transporation benefits
d. Reduction in case management - ANSWER >>>>a.
Disease management programs
In the CMS Star Ratings program, which measure is given the
highest weight?
a. Outcomes
,b. Patient experience
c. Customer service
d. Accurate RAF scores - ANSWER >>>>a. Outcomes
How often are HEDIS measures revised?
a. As needed
b. Monthly
c. Bi-annually
d. Annually - ANSWER >>>>d. Annually
Which statement is TRUE regarding the CMS Stars quality
rating system?
a. Quality bonus payments are made to physician who score
at least four stars.
b. Quality bonus payments are made to Medicare Advantage
plans who score at least four stars.
c. Quality bonus payments are made to physician who score
at least five stars.
d. Quality bonus payments are made to Medicare Advantage
plans who score at least five stars. - ANSWER >>>>b. Quality
bonus payments are made to Medicare Advantage plans who
score at least four stars.
Merit-based Incentive Payment System (MIPS) includes
which performance categories?
I. Promoting Interoperability
II. Cost
III. Improvement Activities
IV. Quantity
V. Quality
a. I and II
b. I, III, and V
,c. I, II, III, and V
d. I, II, III, IV, and V - ANSWER >>>>c. I, II, III, and V
Which of the following are domains in CMS Part C & D Stars
Rating?
I. Staying Healthy
II. Managing Chronic Conditions
III. Member Experience with Health Plans
IV. Member Complaints, Problems Getting Services, and
Improvement in the Health Plan's Performance
V. Health Plan Customer Service
a. I, II and III
b. I, III, and V
c. I, II, III, IV and V
d. I, II, III and V - ANSWER >>>>c. I, II, III, IV and V
What are the participation tracks available through Medicare
Access and CHIP Reauthorization Act (MACRA)?
I. Merit-based Incentive Payment Systems
II. Sustainable Growth System
III. Advanced Alternative Payment Models
a. I
b. II and III
c. I and III
d. I, II and III - ANSWER >>>>c. I and III
What is predictive modeling?
a. An analytical review of known data elements to establish a
hypothesis related to the future health of patients.
b. An analytical review of payments to health plans to
determine the cost of future healthcare.
, c. An average of costs associated with diagnoses used to
determine which providers to contract with for a health plan.
d. An average payment associated with diagnoses used to
determine which health plans providers should contract with. -
ANSWER >>>>a. An analytical review of known data
elements to establish a hypothesis related to the future health
of patients.
Who developed and maintains HEDIS?
a. CMS
b. OIG
c. BCBS
d. NCQA - ANSWER >>>>d. NCQA
What do the Star Ratings identify?
a. Top performing health plans based on quality
b. Top performing doctors based on quality
c. Cost of healthcare in facilities
d. Cost of healthcare by provider - ANSWER >>>>a. Top
performing health plans based on quality
What is the goal of HEDIS?
a. Allow for patients to rate their physicians.
b. Allow patients to compare health plans.
c. Allow patients to schedule appointments online.
d. Allow patients to access their medical records. - ANSWER
>>>>b. Allow patients to compare health plans.
When are Star Ratings are publicly published?
a. January of each year.
b. January and June of each year.
c. October of each year.
