Risk Adjustment CRC exam questions and answers graded A+

Risk Adjustment CRC exam questions and answers graded A+ Interactions What are extra RA values or factors added when a patient has more than one major significant dx identified in model ? Quality, Promoting Interoperability, Improvement Activity, Cost MIPS Collection Types Categories When are Star Ratings publicly published? October of each year HEDIS types of collection Surveys, Medical Chart Reviews, Insurance Claims, Medical Office Visits, Procedures What does Abbreviation MAC stand for? Medicare Administrative Contractor Each year, Medicare normalizes risk scores to maintain an average of what? 1.0 Which type of documentation can be used to support diagnoses reported under risk adjustment models? Inpatient admission note Risk adjustment models are used to: Determine projected costs of health care based on the condition(s) of patients When submitting records for RADV audit, will additional current diagnoses that were not originally reported be considered when documentation is submitted for the audit? Yes, additional current diagnoses not included on claims data may be approved during the audit. For commercial plans, funding is allocated based on Current year's known diagnoses What is the impact on reimbursement under the risk adjustment model if chronic conditions are not coded properly? Failure to code for a chronic condition the patient has may result in an inaccurate RAF. What is the purpose of a RADV To evaluate the appropriateness of risk scores to patients. How many records are submitted by health plans per patient in a RADV audit? 5 Each record submitted for a RADV should include: I. Complete list and legible records 2. Credential for the rendering provider 3.Provider signature or attestation How is predictive modeling used in risk adjustment? Determine suspected diagnoses based on data elements. What might happen as a result of predictive modeling? Disease Management Programs In the CMS Star Ratings program, which measure is given the highest weight? Outcomes The results of a RADV audit are extrapolated across all members of the plan that was audited. What does this mean? Financial penalties will be averaged over the plan membership Retrospective audits generally include finding additional diagnoses, CMS has stated that the deletion of conditions needs to be part of these audits; why is it so hard for companies to follow CMS directives? 1. There is a potential of loss of revenue 2. Billing compliance issues might come too light RADV/IVA audit submissions typically require: provider signature, credentials, and two patient ID's. The printed provider name is only necessary when the signature is illegible and there is a need to identify the provider. Which statements are TRUE regarding retrospective audits? 1.Can be performed by internal employees. 2.Can be performed by external consultants who sign a business agreement 3. Performed after data was submitted If a medical record has conflicting information documented, how is it resolved? provider is queried and an addendum/late entry is created to address the conflicting information. Patient diagnosed with severe protein calorie malnutrition. What is the appropriate diagnosis coding? E43 Which ICD-10-CM code(s) is/are reported when the provider diagnoses the patient with adult attention deficit disorder (ADD)? F98.8 Patient