AAPC CRC PRACTICE EXAM 1
CORRECT 100%
Which provider is NOT an approved provider for diagnosis code capture under the HCC
model?
A. LCSW
B. CRNA
C. Podiatrist
D. Registered nurse - ANSWERD. Registered nurse
Which element would NOT be taken into consideration for predictive modeling in risk
adjustment?
A. The number of years a patient has been covered under Medicare Advantage
B. Gender
C. Procedure codes
D. Place of service - ANSWERA. The number of years a patient has been covered
under Medicare Advantage
Which medical record(s) can be submitted for HCC validation?
I. Physician office progress note
II. Outpatient Hospital
III. Critical Access Hospital
IV. Laboratory test results
V. Diagnostic X-rays
A. I, II, and III
B. IV
C. I, II, III, and IV
D. I, II, III, IV, and V - ANSWERA. I, II, and III
Which statement is coded as a history of condition?
A. Patient presents with a history of colon cancer. He is currently getting chemotherapy
administered by his oncologist.
B. Patient has a history of osteoarthritis currently taking celebrex.
C. Patient presents with CHF complaining of shortness of breath.
D. Patient has a history of breast cancer and sees her oncologist routinely. -
ANSWERD. Patient has a history of breast cancer and sees her oncologist routinely.
Which of the following general statements is NOT TRUE regarding Risk Adjustment
practices and Star Quality Ratings?
, A. Health Care Plans with Four Star Quality Ratings can still improve their STARS score
because the highest rating is a Five
B. From a data discovery perspective, risk adjustment and quality measures are
inseparable
C. Prospective members can review Medicare Advantage plans' Star Quality rating prior
to enrollment
D. Quality Measures like Star Ratings and HEDIS have no correlation with the medical
record information that is collected in support of risk adjustment - ANSWERB. From a
data discovery perspective, risk adjustment and quality measures are inseparable
Which risk adjustment model is used by Medicaid programs?
A. HCC
B. CDPS
C. ZIPC
D. MIPS - ANSWERB. CDPS
What does CMS' Star Ratings program monitor?
A. Performance of Medicare Advantage plans
B. Fraud and abuse
C. Adherence to state scope of practice
D. Performance of Medicare providers - ANSWERA. Performance of Medicare
Advantage plans
Which statement is TRUE regarding hierarchies?
A. Used exclusively by CMS for Medicare Advantage plans
B. Mandated to be used for all Medicaid payment models
C. Utilized by some private payers
D. All of the above - ANSWERC. Utilized by some private payers
Which code set is used for HCC coding?
I. CPT
II. HCPCS Level II
III. ICD-10-CM
IV. ICD-10-PCS
A. III
B. III and IV
C. I and III
D. I, II, III and IV - ANSWERA. III
Data mining is performed for what purpose?
CORRECT 100%
Which provider is NOT an approved provider for diagnosis code capture under the HCC
model?
A. LCSW
B. CRNA
C. Podiatrist
D. Registered nurse - ANSWERD. Registered nurse
Which element would NOT be taken into consideration for predictive modeling in risk
adjustment?
A. The number of years a patient has been covered under Medicare Advantage
B. Gender
C. Procedure codes
D. Place of service - ANSWERA. The number of years a patient has been covered
under Medicare Advantage
Which medical record(s) can be submitted for HCC validation?
I. Physician office progress note
II. Outpatient Hospital
III. Critical Access Hospital
IV. Laboratory test results
V. Diagnostic X-rays
A. I, II, and III
B. IV
C. I, II, III, and IV
D. I, II, III, IV, and V - ANSWERA. I, II, and III
Which statement is coded as a history of condition?
A. Patient presents with a history of colon cancer. He is currently getting chemotherapy
administered by his oncologist.
B. Patient has a history of osteoarthritis currently taking celebrex.
C. Patient presents with CHF complaining of shortness of breath.
D. Patient has a history of breast cancer and sees her oncologist routinely. -
ANSWERD. Patient has a history of breast cancer and sees her oncologist routinely.
Which of the following general statements is NOT TRUE regarding Risk Adjustment
practices and Star Quality Ratings?
, A. Health Care Plans with Four Star Quality Ratings can still improve their STARS score
because the highest rating is a Five
B. From a data discovery perspective, risk adjustment and quality measures are
inseparable
C. Prospective members can review Medicare Advantage plans' Star Quality rating prior
to enrollment
D. Quality Measures like Star Ratings and HEDIS have no correlation with the medical
record information that is collected in support of risk adjustment - ANSWERB. From a
data discovery perspective, risk adjustment and quality measures are inseparable
Which risk adjustment model is used by Medicaid programs?
A. HCC
B. CDPS
C. ZIPC
D. MIPS - ANSWERB. CDPS
What does CMS' Star Ratings program monitor?
A. Performance of Medicare Advantage plans
B. Fraud and abuse
C. Adherence to state scope of practice
D. Performance of Medicare providers - ANSWERA. Performance of Medicare
Advantage plans
Which statement is TRUE regarding hierarchies?
A. Used exclusively by CMS for Medicare Advantage plans
B. Mandated to be used for all Medicaid payment models
C. Utilized by some private payers
D. All of the above - ANSWERC. Utilized by some private payers
Which code set is used for HCC coding?
I. CPT
II. HCPCS Level II
III. ICD-10-CM
IV. ICD-10-PCS
A. III
B. III and IV
C. I and III
D. I, II, III and IV - ANSWERA. III
Data mining is performed for what purpose?
