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AAPC CRC Exam 1 | 180+ Actual Questions & Correct Detailed
Answers with Rationales | Verified & Graded A+ Study Pack
2026/2027 Frequently Most Tested Questions and 100%
Accurate From Past papers | Graded A+ , Reviewed and
Updated | 100% Guarantee Pass | Latest Exam and
Newest Version!!!
,QUESTION
Which provider is NOT an approved provider for diagnosis code capture under the HCC
model?
a. Licensed Clinical Social Worker (LCSW)
b. Certified Registered Nurse Anesthetist (CRNA)
c. Podiatrist
d. Registered Nurse (RN)
✔️ Correct Answer: D
Rationale:
Registered Nurses (RNs) are not approved providers for diagnosis code capture under
the Hierarchical Condition Category (HCC) model (Option D). The HCC model requires
that diagnoses be documented by qualified healthcare providers who are authorized to
make medical diagnoses, including physicians (MD/DO), nurse practitioners (NP),
physician assistants (PA), and certain other licensed providers such as podiatrists and
clinical social workers within their scope of practice. RNs, while essential members of the
healthcare team, do not have the independent diagnostic authority required for HCC
coding. Diagnosis codes for risk adjustment must be derived from face-to-face
encounters with approved providers who can attest to the patient's medical conditions.
Options A, B, and C are incorrect because LCSWs, CRNAs, and podiatrists are recognized
as approved providers for diagnosis code capture within their respective scopes of
practice under the HCC model. Each of these providers may document diagnoses that are
used for risk adjustment when the diagnosis is within their area of clinical expertise and
scope of practice.
,Which element would NOT be taken into consideration for predictive modeling in risk
adjustment?
a. The number of years a patient has been covered under Medicare Advantage
b. Gender
c. Procedure codes
d. Place of service
✔️ Correct Answer: A
Rationale:
The number of years a patient has been covered under Medicare Advantage is NOT
taken into consideration for predictive modeling in risk adjustment (Option A). Predictive
modeling in risk adjustment uses demographic factors and clinical data to predict future
healthcare costs and utilization. Key elements considered include demographic variables
such as age, gender (Option B), and Medicaid status, as well as clinical factors including
diagnosis codes, procedure codes (Option C), and place of service (Option D). The
duration of Medicare Advantage enrollment does not predict future healthcare costs as
effectively as the patient's current health status and chronic conditions.
Options B, C, and D are incorrect because gender, procedure codes, and place of service
are all important elements in predictive modeling. Gender is a demographic factor
associated with different healthcare utilization patterns. Procedure codes provide
information about medical interventions and severity. Place of service indicates the
setting of care, which can reflect the complexity and intensity of services provided.
Which medical record(s) can be submitted for HCC validation?
, I. Physician office progress note
II. Outpatient Hospital
III. Critical Access Hospital
IV. Laboratory test results
V. Diagnostic X-rays
a. I, II, and III
b. IV only
c. I, II, III, and IV
d. I, II, III, IV, and V
✔️ Correct Answer: A
Rationale:
Physician office progress notes (I), outpatient hospital records (II), and Critical Access
Hospital records (III) can be submitted for HCC validation (Option A). These records
contain the clinical documentation necessary to support diagnosis codes, including the
provider's assessment, evaluation, and treatment plan. For HCC validation, the medical
record must demonstrate that the diagnosis was established by an approved provider
during a face-to-face encounter and meet MEAT criteria (Monitoring, Evaluation,
Assessment, Treatment).
Option IV (laboratory test results) and Option V (diagnostic X-rays) are incorrect because
laboratory and radiology results alone do not constitute a medical record for HCC
validation. While these test results may support a diagnosis, they must be accompanied
by a provider's interpretation and clinical correlation to be considered valid
documentation. Laboratory and imaging results are considered ancillary documentation
and are not sufficient on their own to validate a diagnosis for risk adjustment purposes.
BANK
AAPC CRC Exam 1 | 180+ Actual Questions & Correct Detailed
Answers with Rationales | Verified & Graded A+ Study Pack
2026/2027 Frequently Most Tested Questions and 100%
Accurate From Past papers | Graded A+ , Reviewed and
Updated | 100% Guarantee Pass | Latest Exam and
Newest Version!!!
,QUESTION
Which provider is NOT an approved provider for diagnosis code capture under the HCC
model?
a. Licensed Clinical Social Worker (LCSW)
b. Certified Registered Nurse Anesthetist (CRNA)
c. Podiatrist
d. Registered Nurse (RN)
✔️ Correct Answer: D
Rationale:
Registered Nurses (RNs) are not approved providers for diagnosis code capture under
the Hierarchical Condition Category (HCC) model (Option D). The HCC model requires
that diagnoses be documented by qualified healthcare providers who are authorized to
make medical diagnoses, including physicians (MD/DO), nurse practitioners (NP),
physician assistants (PA), and certain other licensed providers such as podiatrists and
clinical social workers within their scope of practice. RNs, while essential members of the
healthcare team, do not have the independent diagnostic authority required for HCC
coding. Diagnosis codes for risk adjustment must be derived from face-to-face
encounters with approved providers who can attest to the patient's medical conditions.
Options A, B, and C are incorrect because LCSWs, CRNAs, and podiatrists are recognized
as approved providers for diagnosis code capture within their respective scopes of
practice under the HCC model. Each of these providers may document diagnoses that are
used for risk adjustment when the diagnosis is within their area of clinical expertise and
scope of practice.
,Which element would NOT be taken into consideration for predictive modeling in risk
adjustment?
a. The number of years a patient has been covered under Medicare Advantage
b. Gender
c. Procedure codes
d. Place of service
✔️ Correct Answer: A
Rationale:
The number of years a patient has been covered under Medicare Advantage is NOT
taken into consideration for predictive modeling in risk adjustment (Option A). Predictive
modeling in risk adjustment uses demographic factors and clinical data to predict future
healthcare costs and utilization. Key elements considered include demographic variables
such as age, gender (Option B), and Medicaid status, as well as clinical factors including
diagnosis codes, procedure codes (Option C), and place of service (Option D). The
duration of Medicare Advantage enrollment does not predict future healthcare costs as
effectively as the patient's current health status and chronic conditions.
Options B, C, and D are incorrect because gender, procedure codes, and place of service
are all important elements in predictive modeling. Gender is a demographic factor
associated with different healthcare utilization patterns. Procedure codes provide
information about medical interventions and severity. Place of service indicates the
setting of care, which can reflect the complexity and intensity of services provided.
Which medical record(s) can be submitted for HCC validation?
, I. Physician office progress note
II. Outpatient Hospital
III. Critical Access Hospital
IV. Laboratory test results
V. Diagnostic X-rays
a. I, II, and III
b. IV only
c. I, II, III, and IV
d. I, II, III, IV, and V
✔️ Correct Answer: A
Rationale:
Physician office progress notes (I), outpatient hospital records (II), and Critical Access
Hospital records (III) can be submitted for HCC validation (Option A). These records
contain the clinical documentation necessary to support diagnosis codes, including the
provider's assessment, evaluation, and treatment plan. For HCC validation, the medical
record must demonstrate that the diagnosis was established by an approved provider
during a face-to-face encounter and meet MEAT criteria (Monitoring, Evaluation,
Assessment, Treatment).
Option IV (laboratory test results) and Option V (diagnostic X-rays) are incorrect because
laboratory and radiology results alone do not constitute a medical record for HCC
validation. While these test results may support a diagnosis, they must be accompanied
by a provider's interpretation and clinical correlation to be considered valid
documentation. Laboratory and imaging results are considered ancillary documentation
and are not sufficient on their own to validate a diagnosis for risk adjustment purposes.
