CRC Chapter 7- Risk Adjustment Models with All Correct & 100%
Verified Answers |Latest Update |Already Graded A+
1. 2. When are prospective
re- views performed? ANS: A
a. Prior to the diagnosis Rationale: Prospective reviews are similar to
and concurrent but are called prospective because when
considering the current
risk factor data being reported year's encounters, these will attect the next year and
not the
to CMS. current year where payment is concerned.
b. After the diagnosis and
risk factor data has been
reported to CMS.
c. Once the patient is
enrolled in a Medicare Part
C plan.
d. Once the provider has fi-
nalized the documentation
to submit diagnosis codes.
2. 3. Which provider is NOT an
approved provider for
diagno- sis code capture ANS: D
under the Medicare HCC Rationale: There is a list of approved providers found in
model?
the chapter. Registered nurses are not on the list
a. Gynecologist
b. Pathologist
c. Oral surgeon
d. Registered nurse
.
3. 4. Where can a list of diagnosis ANS: B
mappings to HCCs be Rationale: Each year, CMS publishes the list of
located? di- agnosis codes that risk adjust, and the
a. OIG website c. OCR HCC that
website
b. CMS website d. QPP website it adjusts to in the model. The information can be
found at
1/
13
, CRC Chapter 7- Risk Adjustment Models with All Correct & 100%
Verified Answers |Latest Update |Already Graded A+
www.cms.gov/Medicare/Health-Plans/MedicareAd-
vtgSpecRateStats/Risk-Adjustors.html
4.
2/
13
Verified Answers |Latest Update |Already Graded A+
1. 2. When are prospective
re- views performed? ANS: A
a. Prior to the diagnosis Rationale: Prospective reviews are similar to
and concurrent but are called prospective because when
considering the current
risk factor data being reported year's encounters, these will attect the next year and
not the
to CMS. current year where payment is concerned.
b. After the diagnosis and
risk factor data has been
reported to CMS.
c. Once the patient is
enrolled in a Medicare Part
C plan.
d. Once the provider has fi-
nalized the documentation
to submit diagnosis codes.
2. 3. Which provider is NOT an
approved provider for
diagno- sis code capture ANS: D
under the Medicare HCC Rationale: There is a list of approved providers found in
model?
the chapter. Registered nurses are not on the list
a. Gynecologist
b. Pathologist
c. Oral surgeon
d. Registered nurse
.
3. 4. Where can a list of diagnosis ANS: B
mappings to HCCs be Rationale: Each year, CMS publishes the list of
located? di- agnosis codes that risk adjust, and the
a. OIG website c. OCR HCC that
website
b. CMS website d. QPP website it adjusts to in the model. The information can be
found at
1/
13
, CRC Chapter 7- Risk Adjustment Models with All Correct & 100%
Verified Answers |Latest Update |Already Graded A+
www.cms.gov/Medicare/Health-Plans/MedicareAd-
vtgSpecRateStats/Risk-Adjustors.html
4.
2/
13
