Question 1
How many charts can be submitted to CMS to validate an HCC?
A. One
B. Three
C. Two
D. Five
CORRECT ANSWER
D. Five
Question 2
The results of a RADV audit are extrapolated across all members of the plan that was
audited. What does this mean?
A. Financial penalties will be limited to each specific member
B. Financial penalties will be averaged over the plan membership
C. Financial penalties will be imposed across the plan membership
D. Financial penalties will not be imposed until two years post audit
CORRECT ANSWER
C. Financial penalties will be imposed across the plan membership
Question 3
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,Retrospective audits generally include finding additional diagnoses. CMS has stated that
the deletion of conditions needs to be part of these audits. What might happen when a
health plan deletes unsupported diagnoses that were submitted on a claim?
I. There is a potential of loss of revenue
II. Billing compliance issues might come too light
III. All companies follow CMS directives
A. I and II
B. I
C. I and III
D. III
CORRECT ANSWER
A. I and II
Question 4
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. Medical record does not include the credentials of the treating provider
Question 5
Which diagnoses can be coded from a medical record that states a member has the
condition, but does not contain supporting documentation?
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, 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. I, III, V, and VI
Question 6
RADV/IVA audit submissions typically require:
I. Provider printed name
II. Two patient identifiers
III. Provider's signature
IV. Must include specialist consultationsV. 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. II and III
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How many charts can be submitted to CMS to validate an HCC?
A. One
B. Three
C. Two
D. Five
CORRECT ANSWER
D. Five
Question 2
The results of a RADV audit are extrapolated across all members of the plan that was
audited. What does this mean?
A. Financial penalties will be limited to each specific member
B. Financial penalties will be averaged over the plan membership
C. Financial penalties will be imposed across the plan membership
D. Financial penalties will not be imposed until two years post audit
CORRECT ANSWER
C. Financial penalties will be imposed across the plan membership
Question 3
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,Retrospective audits generally include finding additional diagnoses. CMS has stated that
the deletion of conditions needs to be part of these audits. What might happen when a
health plan deletes unsupported diagnoses that were submitted on a claim?
I. There is a potential of loss of revenue
II. Billing compliance issues might come too light
III. All companies follow CMS directives
A. I and II
B. I
C. I and III
D. III
CORRECT ANSWER
A. I and II
Question 4
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. Medical record does not include the credentials of the treating provider
Question 5
Which diagnoses can be coded from a medical record that states a member has the
condition, but does not contain supporting documentation?
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, 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. I, III, V, and VI
Question 6
RADV/IVA audit submissions typically require:
I. Provider printed name
II. Two patient identifiers
III. Provider's signature
IV. Must include specialist consultationsV. 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. II and III
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