WITH ANSWERS GRADED A+
◉ RAF. Answer: Risk Adjustment Factor Scores
◉ Three main types of reviews. Answer: Retrospective, Concurrent and
prospective
◉ Retrospective. Answer: reviews are performed after the information
has been reported and in risk adjustment these are prior years dos
◉ Concurrent reviews. Answer: performed ongoing as patients are seen
prior to reporting and in risk adjustment the current year
◉ Prospective reviews. Answer: will effect the next year and not the
current year where payment is concerned. They are used to forcast
◉ Types of Risk Adjustment Models(HHS). Answer: HHS hEALTH
AND HUMAN SERVICES hIERARCHICAL
CONDITION(Commercial, individual and small grooup
◉ Types of Risk Adjustment Modles(CDPS). Answer: Chronic Illness
and Disability payment systems(Medicaid)
, ◉ Types of Risk Adjustment Models(HCC-C). Answer: Hierarchical
Condition Category, Part C
◉ Types of Risk Adjustment model (DRG). Answer: Diagnosis Related
Group (Inpatient)
◉ Types of Risk Adjustment model (ACG). Answer: Adjusted Clinical
Groups(Outpatient)
◉ Prescription based program risk adjustment examples:UCSD.
Answer: Medicaid Rx(UCSD)
◉ Prescription based program risk adjustment examples(Dxcg). Answer:
RxGroups(DxCG)
◉ Prescription based program risk adjustment examples(HCC-D).
Answer: Hierarchical Condition Category, Part D(HCC-D
◉ Trump List. Answer: Families or hierarchies set a value base on
severity of illness with more severe diagnoses carrying the overall risk
score for that family.
◉ Stage 1 Pressure Ulcer. Answer: Persistent focal erythema