Chapter 7: Risk Adjustment Models – CRC /
Risk Adjustment Exam Prep | Latest Update
2026 | Questions & Answers | Graded A+
Risk Adjustment - correct answer_______ is a modern methodology that accounts for
known and discovered health data elements.
diagnosis, levels - correct answerAll risk adjustment models use _______ codes to
determine potential patient-level risks;
the models compare ______ of wellness among patients.
age, gender, disability, insurance, socioeconomic, claims - correct answerAdditional
elements taken into consideration in the risk adjustment model include:
1. ____
2. ____
3. ______ status
4. ______ status
5. ______ status
(Medicare, Medicaid, dual-eligible, etc.)
6. ______ data
(procedure codes, place of service codes, etc),
7. Special patient-specific conditions
(enrollment in hospice or ESRD patient)
equal, costs - correct answerRisk adjustment models are used to:
evaluate all patients on an ______ scale;
_____ can vary greatly from one patient to another.
plan, group - correct answerRisk adjustment models level the playing field when
evaluating all patients being treated within a _____ or ______.
higher, spending, future, care, quality of care - correct answerDocumented variables
can aid in identifying those patients who may have a ______ medical need than others.
These variables help to explain:
current trends in healthcare ______
assist in the forecasting of _____ needs of those patients
identify where resources will be necessary to deliver _____ efficiently.
Although some of these variables can affect payment, they all influence ________
endeavors, as patient care needs are identified.
, payment, revenue, projected, high - correct answerFrom a _______ perspective,
risk adjustment models adjust health plan _____ to better reflect the _______ costs of
the patient population and to compensate plans that enroll _____-cost patients.
internal, factor - correct answerHealth plans and risk-bearing provider groups establish:
1. ______ risk adjustment programs to help monitor the patient population
2. improve quality of care
3. increase provider engagement
4. increase accuracy and completeness of data submissions to achieve more accurate
risk adjustment _________ scores
risk adjustment factor - correct answerRAF
retrospective, concurrent, prospective, current - correct answerRisk adjustment
programs include REVIEW of the patient population's HEALTH STATUS and these
generally fall into three main types of review:
1. ____
2. _____
3. ____
These review types are based on the ______ date of service (DOS) compared to the
treatment DOS being reviewed.
Retrospective - correct answer_______ reviews are performed after the information has
been reported; in risk adjustment, these are typically the PRIOR year's DOS
Concurrent - correct answer______ reviews are performed ongoing, as patients are
seen and may be after or prior to reporting; in risk adjustment, these are typically the
CURRENT year, combined with the prior year's DOS.
Prospective - correct answer_______ reviews are like concurrent but are called
prospective because when considering the current year's encounters, these will affect
the next year and not the current year, where payment is concerned.
home assessments - correct answerIn risk adjustment, risk assessments to include
_______ are often called prospective. These various medical documentation reviews
are used to forecast future healthcare needs, while explaining current needs and
expenses.
ICD-10-CM - correct answerCoders who are well versed on proper diagnosis coding,
_______ coding guidelines, as well as directives from The Coding Clinic® are
imperative for correct diagnosis code selection and a successful risk adjustment
program.
hierarchal condition categories - correct answer__________________ (HCC); The
model filters
ICD-10-CM codes --->
Risk Adjustment Exam Prep | Latest Update
2026 | Questions & Answers | Graded A+
Risk Adjustment - correct answer_______ is a modern methodology that accounts for
known and discovered health data elements.
diagnosis, levels - correct answerAll risk adjustment models use _______ codes to
determine potential patient-level risks;
the models compare ______ of wellness among patients.
age, gender, disability, insurance, socioeconomic, claims - correct answerAdditional
elements taken into consideration in the risk adjustment model include:
1. ____
2. ____
3. ______ status
4. ______ status
5. ______ status
(Medicare, Medicaid, dual-eligible, etc.)
6. ______ data
(procedure codes, place of service codes, etc),
7. Special patient-specific conditions
(enrollment in hospice or ESRD patient)
equal, costs - correct answerRisk adjustment models are used to:
evaluate all patients on an ______ scale;
_____ can vary greatly from one patient to another.
plan, group - correct answerRisk adjustment models level the playing field when
evaluating all patients being treated within a _____ or ______.
higher, spending, future, care, quality of care - correct answerDocumented variables
can aid in identifying those patients who may have a ______ medical need than others.
These variables help to explain:
current trends in healthcare ______
assist in the forecasting of _____ needs of those patients
identify where resources will be necessary to deliver _____ efficiently.
Although some of these variables can affect payment, they all influence ________
endeavors, as patient care needs are identified.
, payment, revenue, projected, high - correct answerFrom a _______ perspective,
risk adjustment models adjust health plan _____ to better reflect the _______ costs of
the patient population and to compensate plans that enroll _____-cost patients.
internal, factor - correct answerHealth plans and risk-bearing provider groups establish:
1. ______ risk adjustment programs to help monitor the patient population
2. improve quality of care
3. increase provider engagement
4. increase accuracy and completeness of data submissions to achieve more accurate
risk adjustment _________ scores
risk adjustment factor - correct answerRAF
retrospective, concurrent, prospective, current - correct answerRisk adjustment
programs include REVIEW of the patient population's HEALTH STATUS and these
generally fall into three main types of review:
1. ____
2. _____
3. ____
These review types are based on the ______ date of service (DOS) compared to the
treatment DOS being reviewed.
Retrospective - correct answer_______ reviews are performed after the information has
been reported; in risk adjustment, these are typically the PRIOR year's DOS
Concurrent - correct answer______ reviews are performed ongoing, as patients are
seen and may be after or prior to reporting; in risk adjustment, these are typically the
CURRENT year, combined with the prior year's DOS.
Prospective - correct answer_______ reviews are like concurrent but are called
prospective because when considering the current year's encounters, these will affect
the next year and not the current year, where payment is concerned.
home assessments - correct answerIn risk adjustment, risk assessments to include
_______ are often called prospective. These various medical documentation reviews
are used to forecast future healthcare needs, while explaining current needs and
expenses.
ICD-10-CM - correct answerCoders who are well versed on proper diagnosis coding,
_______ coding guidelines, as well as directives from The Coding Clinic® are
imperative for correct diagnosis code selection and a successful risk adjustment
program.
hierarchal condition categories - correct answer__________________ (HCC); The
model filters
ICD-10-CM codes --->
