CRC Practice Exam B Questions With 100% Correct Answers

CRC Practice Exam B Questions With 100% Correct Answers How many charts can be submitted to CMS to validate an HCC? A. One B. Three C. Two D. Five - answerD RADV to permits 5 medical records to be submitted for each HCC to be validated. 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 - answerC CMS has stated that HCC risk factors will be spread across all members in that plan. Example: Member A had HCC22 to be validated, the value of that HCC is $2, it could not be validated. The plan membership is 200 members; that one missed HCC cost the company $400 which CMS will take back from the company. Retrospective audits generally include finding additional diagnoses, CMS has stated that the deletion of conditions needs to be part of these audits; why is it so hard for companies to follow CMS directives? 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 - answerA These audits can mandate that insurance companies repay CMS for past revenues which will decrease the bottom line for the stock holders. Billing compliance issues might come into play and a deeper dive might be warranted for specific provider offices which will cause abrasion with the providers. 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 - answerC CMS RAPS Participant Guide states that all documentation must be signed by the rendering provider.As stated in CMS' 2008 Call Letter (available on the CMS web site at purposes of risk adjustment data submission and validation, the MA organizations must ensure that the provider of service for face-to-face encounters is appropriately identified on medical records via their signature and physician specialty credentials. (Examples of acceptable physician signatures are: handwritten signature or initials; signature stamp that complies with state regulations; and electronic signature with authentication by the respective provider.) This means that the credentials for the provider of services must be somewhere on the medical record—either next to the provider's signature or pre-printed with the provider's name on the group practice's stationery. If the provider of services is not listed on the stationery, then the credentials must be part of the signature for that provider. In these instances, the coders are able to determine that the beneficiary was evaluated by a physician or an acceptable physician specialty. Which diagnoses can be coded from a medical record that states a member has the condition, but does not contain supporting documentation? I. COPD II. Croup III. A-FibIV. 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 - answerD The Official Guidelines for Coding and Reporting for Outpatient Services IV.I. and IV.J., state, "Chronic diseases treated on an ongoing basis may be coded and reported as many times as the patient receives treatment and care for the conditions(s) and "Code all documented conditions that coexist at the time of the encounter/visit and require or affect patient care treatment or management. Do not code conditions that were previously treated and no longer exist." This information was previously published in Coding Clinic, Fourth Quarter 2006, pages 236- 240.CMS RAPS Participant Manual: Co-existing conditions include chronic, ongoing conditions such as diabetes (250.XX, HCCs 15-19), congestive heart failure (428.0, HCC 80), atrial fibrillation (427.31, HCC 92), chronic obstructive and pulmonary disease (496, HCC 108). These diseases are generally managed by ongoing medication and have the potential for acute exacerbations if not treated properly, particularly if the patient is experiencing other acute conditions. It is likely that these diagnoses would be part of a general overview of the patient's health when treating co-existing conditions for all but the most minor of medical encounters. Co-existing conditions also include ongoing conditions such as multiple sclerosis (340, HCC 72), hemiplegia (342.9X, HCC 100), rheumatoid arthritis (714.0, HCC 38) and Parkinson's disease (332.0, HCC 73). Although they may not impact every minor healthcare episode, it is likely that patients having these conditions would have their general health status evaluated within a data reporting period, and these diagnoses would be documented and reportable at that time. RADV/IVA audit submissions typically require: I. Provider printed name II. Two patient identifiers III. Provider's signature IV. Must include specialist consultations V. 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 - answerA