CRC Exam Questions with 100% Correct Answers Latest Graded A+
Question:
To determine suspected diagnosis based on data elements.
Answer:
how is predictive modeling used in risk adjustment?
Question:
D. I, ii, iii, and iv
Answer:
which of the following data elements are used in predictive modeling?
I. Dme claims
Ii. Prescription drug events
Iii. Physician claims data
Iv. Facility claims data
Question:
A. Iii and iv B. I, ii, and iv C. I, ii, and iii D. I, ii, iii, and iv A. Disease management programs
Answer:
what might happen as a result of predictive modeling?
Question:
A. Disease management programs B. Concurrent audits C. Transporation benefits D. Reduction in
case management A. Outcomes
Answer:
in the cms star ratings program, which measure is given the highest weight?
Question:
A. Outcomes B. Patient experience C. Customer service D. Accurate raf scores d. Annually
Answer:
,How often are HEDIS measures revised?
Question:
a. As needed b. Monthly c. Bi-annually d. Annually b. Quality bonus payments are made to
Medicare Advantage plans who score at least four stars.
Answer:
Which statement is TRUE regarding the CMS Stars quality rating system?
Question:
a. Quality bonus payments are made to physician who score at least four stars. b. Quality bonus
payments are made to Medicare Advantage plans who score at least four stars. c. Quality bonus
payments are made to physician who score at least five stars. d. Quality bonus payments are made
to Medicare Advantage plans who score at least five stars. c. I, II, III, and V
Answer:
Merit-based Incentive Payment System (MIPS) includes which performance categories?
I. Promoting Interoperability
II. Cost
III. Improvement Activities
IV. Quantity
V. Quality
Question:
a. I and II b. I, III, and V c. I, II, III, and V d. I, II, III, IV, and V c. I, II, III, IV and V
Answer:
Which of the following are domains in CMS Part C & D Stars Rating?
I. Staying Healthy
II. Managing Chronic Conditions
III. Member Experience with Health Plans
IV. Member Complaints, Problems Getting Services, and Improvement in the Health Plan's
Performance
,V. Health Plan Customer Service
Question:
a. I, II and III b. I, III, and V c. I, II, III, IV and V d. I, II, III and V c. I and III
Answer:
What are the participation tracks available through Medicare Access and CHIP Reauthorization Act
(MACRA)?
I. Merit-based Incentive Payment Systems
II. Sustainable Growth System
III. Advanced Alternative Payment Models
Question:
a. I b. II and III c. I and III d. I, II and III a. An analytical review of known data elements to
establish a hypothesis related to the future health of patients.
Answer:
What is predictive modeling?
Question:
a. An analytical review of known data elements to establish a hypothesis related to the future health
of patients. b. An analytical review of payments to health plans to determine the cost of future
healthcare. c. An average of costs associated with diagnoses used to determine which providers to
contract with for a health plan. d. An average payment associated with diagnoses used to determine
which health plans providers should contract with. d. NCQA
Answer:
Who developed and maintains HEDIS?
Question:
a. CMS b. OIG c. BCBS d. NCQA a. Top performing health plans based on quality
Answer:
What do the Star Ratings identify?
Question:
a. Top performing health plans based on quality b. Top performing doctors based on quality c. Cost
of healthcare in facilities d. Cost of healthcare by provider b. Allow patients to compare health
, plans.
Answer:
What is the goal of HEDIS?
Question:
a. Allow for patients to rate their physicians. b. Allow patients to compare health plans. c. Allow
patients to schedule appointments online. d. Allow patients to access their medical records. c.
October of each year.
Answer:
When are Star Ratings are publicly published?
Question:
a. January of each year. b. January and June of each year. c. October of each year. d. April and
October of each year b. Determine suspected diagnoses based on data elements.
Answer:
How is predictive modeling used in risk adjustment?
Question:
a. Determine the RAF score in HCC compared to FFS. b. Determine suspected diagnoses based on
data elements. c. Determine the correct enrollment process. d. Determine the return on investment
for hiring coders. b. Asthma
Answer:
If you were using predictive modeling and the results were:
• Rx Claim: Albuterol (quick-relief inhaler)
• Medical Claim: Pulmonary Function Test
• DME claim: Home Nebulizer
Question:
a. Diabetes mellitus b. Asthma c. Osteoporosis d. Hypertension d. Osteoporosis
Answer:
If you were using a predictive model and the results were:
• The member had a DME claim for a cane.
Question:
To determine suspected diagnosis based on data elements.
Answer:
how is predictive modeling used in risk adjustment?
Question:
D. I, ii, iii, and iv
Answer:
which of the following data elements are used in predictive modeling?
I. Dme claims
Ii. Prescription drug events
Iii. Physician claims data
Iv. Facility claims data
Question:
A. Iii and iv B. I, ii, and iv C. I, ii, and iii D. I, ii, iii, and iv A. Disease management programs
Answer:
what might happen as a result of predictive modeling?
Question:
A. Disease management programs B. Concurrent audits C. Transporation benefits D. Reduction in
case management A. Outcomes
Answer:
in the cms star ratings program, which measure is given the highest weight?
Question:
A. Outcomes B. Patient experience C. Customer service D. Accurate raf scores d. Annually
Answer:
,How often are HEDIS measures revised?
Question:
a. As needed b. Monthly c. Bi-annually d. Annually b. Quality bonus payments are made to
Medicare Advantage plans who score at least four stars.
Answer:
Which statement is TRUE regarding the CMS Stars quality rating system?
Question:
a. Quality bonus payments are made to physician who score at least four stars. b. Quality bonus
payments are made to Medicare Advantage plans who score at least four stars. c. Quality bonus
payments are made to physician who score at least five stars. d. Quality bonus payments are made
to Medicare Advantage plans who score at least five stars. c. I, II, III, and V
Answer:
Merit-based Incentive Payment System (MIPS) includes which performance categories?
I. Promoting Interoperability
II. Cost
III. Improvement Activities
IV. Quantity
V. Quality
Question:
a. I and II b. I, III, and V c. I, II, III, and V d. I, II, III, IV, and V c. I, II, III, IV and V
Answer:
Which of the following are domains in CMS Part C & D Stars Rating?
I. Staying Healthy
II. Managing Chronic Conditions
III. Member Experience with Health Plans
IV. Member Complaints, Problems Getting Services, and Improvement in the Health Plan's
Performance
,V. Health Plan Customer Service
Question:
a. I, II and III b. I, III, and V c. I, II, III, IV and V d. I, II, III and V c. I and III
Answer:
What are the participation tracks available through Medicare Access and CHIP Reauthorization Act
(MACRA)?
I. Merit-based Incentive Payment Systems
II. Sustainable Growth System
III. Advanced Alternative Payment Models
Question:
a. I b. II and III c. I and III d. I, II and III a. An analytical review of known data elements to
establish a hypothesis related to the future health of patients.
Answer:
What is predictive modeling?
Question:
a. An analytical review of known data elements to establish a hypothesis related to the future health
of patients. b. An analytical review of payments to health plans to determine the cost of future
healthcare. c. An average of costs associated with diagnoses used to determine which providers to
contract with for a health plan. d. An average payment associated with diagnoses used to determine
which health plans providers should contract with. d. NCQA
Answer:
Who developed and maintains HEDIS?
Question:
a. CMS b. OIG c. BCBS d. NCQA a. Top performing health plans based on quality
Answer:
What do the Star Ratings identify?
Question:
a. Top performing health plans based on quality b. Top performing doctors based on quality c. Cost
of healthcare in facilities d. Cost of healthcare by provider b. Allow patients to compare health
, plans.
Answer:
What is the goal of HEDIS?
Question:
a. Allow for patients to rate their physicians. b. Allow patients to compare health plans. c. Allow
patients to schedule appointments online. d. Allow patients to access their medical records. c.
October of each year.
Answer:
When are Star Ratings are publicly published?
Question:
a. January of each year. b. January and June of each year. c. October of each year. d. April and
October of each year b. Determine suspected diagnoses based on data elements.
Answer:
How is predictive modeling used in risk adjustment?
Question:
a. Determine the RAF score in HCC compared to FFS. b. Determine suspected diagnoses based on
data elements. c. Determine the correct enrollment process. d. Determine the return on investment
for hiring coders. b. Asthma
Answer:
If you were using predictive modeling and the results were:
• Rx Claim: Albuterol (quick-relief inhaler)
• Medical Claim: Pulmonary Function Test
• DME claim: Home Nebulizer
Question:
a. Diabetes mellitus b. Asthma c. Osteoporosis d. Hypertension d. Osteoporosis
Answer:
If you were using a predictive model and the results were:
• The member had a DME claim for a cane.
