CRC EXAM 2024 EXAM REVIEW SOLUTION

CRC EXAM 2024 EXAM REVIEW SOLUTION Risk Adjustment Data Element - Answer-Age, Gende, Socioeconomic status, Disability status, Insurance status(Medicaid, dual-eligible,) Claims data elements such as procedure codes, place of service codes, special patient-specific conditions hospice, ESRD RAF - Answer-Risk Adjustment Factor Scores Three main types of reviews - Answer-Retrospective, Concurrent and prospective Retrospective - Answer-reviews are performed after the information has been reported and in risk adjustment these are prior years dos Concurrent reviews - Answer-performed ongoing as patients are seen prior to reporting and in risk adjustment the current year Prospective reviews - Answer-will effect the next year and not the current year where payment is concerned. They are used to forcast Types of Risk Adjustment Models(HHS) - Answer-HHS hEALTH AND HUMAN SERVICES hIERARCHICAL CONDITION(Commercial, individual and small grooup Types of Risk Adjustment Modles(CDPS) - Answer-Chronic Illness and Disability payment systems(Medicaid) Types of Risk Adjustment Models(HCC-C) - Answer-Hierarchical Condition Category, Part C Types of Risk Adjustment model (DRG) - Answer-Diagnosis Related Group (Inpatient) Types of Risk Adjustment model (ACG) - Answer-Adjusted Clinical Groups(Outpatient) Prescription based program risk adjustment examples:UCSD - Answer