HCC Coding -Risk Adjustment Exam 2023

Risk Adjustment Model - ANSWER Calculates risk scores for all beneficiaries with available data What are the three submission deadlines? - ANSWER 1. First Friday in September = Initial Risk Score 2. First Friday in March = Mid-year Update 3. January 31 after the payment year = Final reconcilation Medicare risk adjustment model is prospective. This means? - ANSWER Diagnoses reported in the prior year and demographic information are utilized to "predict" future costs and adjust payments accordingly Risk Scores. - ANSWER Measures individual beneficiaries' relative risk and are used to adjust payments for each beneficiary's expected expenditures. FERAS Response Report. - ANSWER Rejected data after it has been processed through FERAS is recorded in this report. RAPS Return File - ANSWER This is a daily report that shows all records approved and where errors occurred. RAPS Transaction Error Report - ANSWER Displays records on which errors occurred. RAPS Transaction Summary Report - ANSWER A report sent to the MA organization daily and identifies data that have been finalized in RAPS database Duplicate Diagnosis Cluster Report - ANSWER Shows diagnosis clusters submitted with information that duplicates a stored cluster. RAPS Monthly Plan Activity Report and Cumulative Plan Activity Report - ANSWER Provides a summary of all diagnoses stored for a given time period. Error Frequency Report - ANSWER This report is distributed monthly and quarterly. Provides an overview of all errors associated with files submitted in test and production. RAPS database - ANSWER Stores all finalized diagnosis clusters Risk Adjustment System (RAS) - ANSWER Executes the risk adjustment model and calculates the risk score using the SAS model.