HCC CODING/RISK ADJUSTMENT EXAM
QUESTIONS WITH 100% CORRECT
ANSWERS!!
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.
Medicare Advantage Prescription Drug System (MARx) Answer - Processes
payments to plans and issues the MMR (Monthly Membership Report) and
MOR (Model Output Report).
How often does CMS conduct data validation audits and for what purpose?
Answer - Audits are done annually on selected plans that may have to request
medical record documentation from the providers to support the submitted
diagnoses.
What types of data are checked in FERAS? Answer - File-level, batch-level and
first and last detailed records
, RAPS Return file Answer - Daily reports that shows all records approved and
where errors occurred.
What does File-level information identified? Answer - Submitter
What does Batch-level information identify? Answer - MA organization
What does Detail-level information identify? Answer - Beneficiary
Define Reconciliation Answer - The completion of the implementation of
payments with CMS calculating final risk adjustment factors and beneficiary
stats based on complete data. Necessary adjustments for institutional status
and demographic data for enrollees is considered.
CMS continues to allow a period (approximately 13 months after the data
collection year) for submitting final RAPS data for the appropriate data
collection period.
Is this condition a Probably Forever/Almost ALLS (still has condition even
though mediation or device is covering up symptoms), Forever/ALLS, or a
Chronic condition?
Septicemia (Category 380) Answer - Probably Forever/Almost ALLS
Is this condition a Probably Forever/Almost ALLS (still has condition even
though mediation or device is covering up symptoms), Forever/ALLS, or a
Chronic condition?
QUESTIONS WITH 100% CORRECT
ANSWERS!!
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.
Medicare Advantage Prescription Drug System (MARx) Answer - Processes
payments to plans and issues the MMR (Monthly Membership Report) and
MOR (Model Output Report).
How often does CMS conduct data validation audits and for what purpose?
Answer - Audits are done annually on selected plans that may have to request
medical record documentation from the providers to support the submitted
diagnoses.
What types of data are checked in FERAS? Answer - File-level, batch-level and
first and last detailed records
, RAPS Return file Answer - Daily reports that shows all records approved and
where errors occurred.
What does File-level information identified? Answer - Submitter
What does Batch-level information identify? Answer - MA organization
What does Detail-level information identify? Answer - Beneficiary
Define Reconciliation Answer - The completion of the implementation of
payments with CMS calculating final risk adjustment factors and beneficiary
stats based on complete data. Necessary adjustments for institutional status
and demographic data for enrollees is considered.
CMS continues to allow a period (approximately 13 months after the data
collection year) for submitting final RAPS data for the appropriate data
collection period.
Is this condition a Probably Forever/Almost ALLS (still has condition even
though mediation or device is covering up symptoms), Forever/ALLS, or a
Chronic condition?
Septicemia (Category 380) Answer - Probably Forever/Almost ALLS
Is this condition a Probably Forever/Almost ALLS (still has condition even
though mediation or device is covering up symptoms), Forever/ALLS, or a
Chronic condition?
