CRC Exam Prep | AAPC Certified
Risk Adjustment Specialist Study
Guide
Description: This study guide provides 200 high-yield multiple-choice questions for the
AAPC Certified Risk Adjustment Coder (CRC) exam. It covers ICD-10-CM coding,
Hierarchical Condition Categories (HCCs), risk adjustment models, MEAT criteria, and
compliance/RADV audits.
Keywords: CRC Exam, Risk Adjustment, HCC Coding, AAPC, MEAT Criteria, CMS-HCC
V28, RAF Score, RADV Audits, ICD-10-CM.
Section 1: Risk Adjustment Fundamentals & HCC Models
Q1. What is the primary purpose of the Hierarchical Condition Category (HCC) risk
adjustment model?
A. To calculate the exact cost of a patient's prescriptions
B. To predict future healthcare costs based on a patient's documented diagnoses
C. To determine the medical necessity of a specific surgical procedure
D. To evaluate the clinical competency of a physician
Correct Answer: B ✅
Q2. Which risk adjustment model is primarily used for the Medicare Advantage
population?
A. HHS-HCC
B. CDPS
C. CMS-HCC
D. Medicaid RUGs
,Correct Answer: C ✅
Q3. What demographic factors are utilized in the CMS-HCC model alongside
diagnosis codes to calculate a risk score?
A. Marital status and income level
B. Age, sex, and eligibility status (e.g., dual eligible)
C. Occupation and education level
D. Geographic location and race
Correct Answer: B ✅
Q4. Under the CMS-HCC model, what does the term "Trumping" refer to?
A. The process of deleting a diagnosis from the medical record
B. When a lower-severity HCC overrides a higher-severity HCC in the same family
C. When a higher-severity HCC overrides a lower-severity HCC within the same disease
hierarchy
D. The method used to calculate the age/sex coefficient
Correct Answer: C ✅
Q5. If a patient has documentation for both HCC 8 (Metastatic Cancer) and HCC 9
(Lung Cancer), which HCC will be used to calculate the RAF score?
A. Both HCC 8 and HCC 9
B. HCC 8 only
C. HCC 9 only
D. Neither, as they cancel each other out
Correct Answer: B ✅
Q6. What is the primary purpose of the "MEAT" criteria in risk adjustment coding?
A. To determine the correct CPT code for a surgical procedure
B. To provide a framework to evaluate if a diagnosis is supported by provider
documentation
,C. To calculate the Medicare Part D drug costs
D. To sequence multiple diagnoses on a claim form
Correct Answer: B ✅
Q7. What does the acronym "MEAT" stand for in the context of risk adjustment
documentation?
A. Monitor, Evaluate, Assess, Treat
B. Manage, Examine, Analyze, Test
C. Medicare, Evaluation, Audit, Tracking
D. Medical, Evidence, Assessment, Therapy
Correct Answer: A ✅
Q8. What is a "Relative Adjustment Factor" (RAF) in the CMS-HCC model?
A. A numeric value assigned to a specific demographic group
B. A payment adjustment for geographic location
C. A numeric weight assigned to an HCC that reflects the predicted cost of the condition
D. A penalty applied for coding errors
Correct Answer: C ✅
Q9. Which of the following best describes "prospective" risk adjustment?
A. Using diagnoses from the current year to explain current year costs
B. Using diagnoses from a prior year to predict costs for the following year
C. Adjusting payments based on retrospective chart reviews
D. Calculating risk scores based on patient-reported outcomes
Correct Answer: B ✅
Q10. According to risk adjustment principles, why is code specificity crucial?
A. Vague codes are easier to audit
B. Specific codes map to higher-paying HCCs and accurately reflect the patient's
complexity
, C. Specific codes are required only for inpatient claims
D. Vague codes are preferred by CMS for simplicity
Correct Answer: B ✅
Q11. What is the significance of the "HHS-HCC" model?
A. It is used for the Medicare Advantage population
B. It is used for the commercial/ACA marketplace population
C. It is used exclusively for Medicaid programs
D. It is used for the Veteran's Affairs healthcare system
Correct Answer: B ✅
Q12. Which of the following conditions is a key example of an HCC that is subject
to hierarchy rules (Trumping)?
A. Hypertension
B. Diabetes with complications
C. Asthma
D. Osteoarthritis
Correct Answer: B ✅
Q13. How often must a chronic condition be documented and coded in the CMS-
HCC model to count for risk adjustment for the current payment year?
A. Once every three years
B. At least once per calendar year
C. Only when the patient is hospitalized
D. It does not need to be redocumented
Correct Answer: B ✅
Q14. In the CMS-HCC V28 model, what major change occurred regarding the
mapping of ICD-10-CM codes?
A. The number of mapped codes increased significantly
Risk Adjustment Specialist Study
Guide
Description: This study guide provides 200 high-yield multiple-choice questions for the
AAPC Certified Risk Adjustment Coder (CRC) exam. It covers ICD-10-CM coding,
Hierarchical Condition Categories (HCCs), risk adjustment models, MEAT criteria, and
compliance/RADV audits.
Keywords: CRC Exam, Risk Adjustment, HCC Coding, AAPC, MEAT Criteria, CMS-HCC
V28, RAF Score, RADV Audits, ICD-10-CM.
Section 1: Risk Adjustment Fundamentals & HCC Models
Q1. What is the primary purpose of the Hierarchical Condition Category (HCC) risk
adjustment model?
A. To calculate the exact cost of a patient's prescriptions
B. To predict future healthcare costs based on a patient's documented diagnoses
C. To determine the medical necessity of a specific surgical procedure
D. To evaluate the clinical competency of a physician
Correct Answer: B ✅
Q2. Which risk adjustment model is primarily used for the Medicare Advantage
population?
A. HHS-HCC
B. CDPS
C. CMS-HCC
D. Medicaid RUGs
,Correct Answer: C ✅
Q3. What demographic factors are utilized in the CMS-HCC model alongside
diagnosis codes to calculate a risk score?
A. Marital status and income level
B. Age, sex, and eligibility status (e.g., dual eligible)
C. Occupation and education level
D. Geographic location and race
Correct Answer: B ✅
Q4. Under the CMS-HCC model, what does the term "Trumping" refer to?
A. The process of deleting a diagnosis from the medical record
B. When a lower-severity HCC overrides a higher-severity HCC in the same family
C. When a higher-severity HCC overrides a lower-severity HCC within the same disease
hierarchy
D. The method used to calculate the age/sex coefficient
Correct Answer: C ✅
Q5. If a patient has documentation for both HCC 8 (Metastatic Cancer) and HCC 9
(Lung Cancer), which HCC will be used to calculate the RAF score?
A. Both HCC 8 and HCC 9
B. HCC 8 only
C. HCC 9 only
D. Neither, as they cancel each other out
Correct Answer: B ✅
Q6. What is the primary purpose of the "MEAT" criteria in risk adjustment coding?
A. To determine the correct CPT code for a surgical procedure
B. To provide a framework to evaluate if a diagnosis is supported by provider
documentation
,C. To calculate the Medicare Part D drug costs
D. To sequence multiple diagnoses on a claim form
Correct Answer: B ✅
Q7. What does the acronym "MEAT" stand for in the context of risk adjustment
documentation?
A. Monitor, Evaluate, Assess, Treat
B. Manage, Examine, Analyze, Test
C. Medicare, Evaluation, Audit, Tracking
D. Medical, Evidence, Assessment, Therapy
Correct Answer: A ✅
Q8. What is a "Relative Adjustment Factor" (RAF) in the CMS-HCC model?
A. A numeric value assigned to a specific demographic group
B. A payment adjustment for geographic location
C. A numeric weight assigned to an HCC that reflects the predicted cost of the condition
D. A penalty applied for coding errors
Correct Answer: C ✅
Q9. Which of the following best describes "prospective" risk adjustment?
A. Using diagnoses from the current year to explain current year costs
B. Using diagnoses from a prior year to predict costs for the following year
C. Adjusting payments based on retrospective chart reviews
D. Calculating risk scores based on patient-reported outcomes
Correct Answer: B ✅
Q10. According to risk adjustment principles, why is code specificity crucial?
A. Vague codes are easier to audit
B. Specific codes map to higher-paying HCCs and accurately reflect the patient's
complexity
, C. Specific codes are required only for inpatient claims
D. Vague codes are preferred by CMS for simplicity
Correct Answer: B ✅
Q11. What is the significance of the "HHS-HCC" model?
A. It is used for the Medicare Advantage population
B. It is used for the commercial/ACA marketplace population
C. It is used exclusively for Medicaid programs
D. It is used for the Veteran's Affairs healthcare system
Correct Answer: B ✅
Q12. Which of the following conditions is a key example of an HCC that is subject
to hierarchy rules (Trumping)?
A. Hypertension
B. Diabetes with complications
C. Asthma
D. Osteoarthritis
Correct Answer: B ✅
Q13. How often must a chronic condition be documented and coded in the CMS-
HCC model to count for risk adjustment for the current payment year?
A. Once every three years
B. At least once per calendar year
C. Only when the patient is hospitalized
D. It does not need to be redocumented
Correct Answer: B ✅
Q14. In the CMS-HCC V28 model, what major change occurred regarding the
mapping of ICD-10-CM codes?
A. The number of mapped codes increased significantly
