CRC Practice Exam C With Correct
Questions And Answers 2024
Do .the .HCC .category .hierarchies .play .a .role .in .which .medical .record .to .submit .for .a
.RADV?
I. .No, .there .are .no .benefits .in .taking .hierarchies .into .consideration
II. .No, .CMS .will .treat .all .diagnosis .with .the .same .financial .weight
III. .Yes, .CMS .will .accept .a .lower .or .higher .HCC .to .validate .an .HCC .within .the .same
.category
IV. .Yes, .there .can .be .a .financial .gain .by .submitting .a .higher .hierarchy .HCC .- .correct
.answer.III .and .IV
Retrospective .audits .provide .insurance .companies .with .ability .to .scrub/correct .their .data
.which .accomplishes .which .of .the .following?
I. .Provides .opportunities .to .increase .revenue .by .submitting .additional .codes
II. .Provides .opportunities .to .compare .claims .data .to .the .documentation .and .submit
.deletions .if .the .documentation .does .not .support .what .was .on .the .claim
III. .Provides .opportunities .to .correct .coding .errors .prior .to .data .being .submitted .- .correct
.answer.I .and .II
Which .on .of .the .following .is .an .example .of .fraud? .- .correct .answer.Reporting .a .diabetic
.manifestation .to .increase .the .risk .score.
Medicare .Risk .Adjustment .is .a: .- .correct .answer.Prospective .payment .system
Choose .the .best .medical .record .for .a .RADV .audit .to .include .all .the .diagnoses .in .this
.scenario:• .CMS .is .requesting .diabetes .mellitus .with .neuropathy .to .be .validated• .Assume
.all .the .notes .are .signed .by .the .provider .and .the .diagnoses .are .supported .by .the
.documentation .- .correct .answer.Chart .#2: .DOS .4/2/20XX—Diagnoses: .DM .with
.neurologic .manifestations, .polyneuropathy, .CKD
Which .statement .is .TRUE .regarding .RADV .audits? .- .correct .answer.The .purpose .is .to
.validate .submitted .HCC .data
During .a .retrospective .chart .audit .for .a .XYZ .Medicare .Advantage .Company, .it .is
.determined .a .diagnosis .submitted .is .not .supported .by .medical .record. .There .is .no
.additional .information .to .validate .the .diagnosis. .The .member .is .part .of .a .health .plan .that
.has .1,500 .members .and .the .insurance .company .received .$350 .for .this .diagnosis. .This
Questions And Answers 2024
Do .the .HCC .category .hierarchies .play .a .role .in .which .medical .record .to .submit .for .a
.RADV?
I. .No, .there .are .no .benefits .in .taking .hierarchies .into .consideration
II. .No, .CMS .will .treat .all .diagnosis .with .the .same .financial .weight
III. .Yes, .CMS .will .accept .a .lower .or .higher .HCC .to .validate .an .HCC .within .the .same
.category
IV. .Yes, .there .can .be .a .financial .gain .by .submitting .a .higher .hierarchy .HCC .- .correct
.answer.III .and .IV
Retrospective .audits .provide .insurance .companies .with .ability .to .scrub/correct .their .data
.which .accomplishes .which .of .the .following?
I. .Provides .opportunities .to .increase .revenue .by .submitting .additional .codes
II. .Provides .opportunities .to .compare .claims .data .to .the .documentation .and .submit
.deletions .if .the .documentation .does .not .support .what .was .on .the .claim
III. .Provides .opportunities .to .correct .coding .errors .prior .to .data .being .submitted .- .correct
.answer.I .and .II
Which .on .of .the .following .is .an .example .of .fraud? .- .correct .answer.Reporting .a .diabetic
.manifestation .to .increase .the .risk .score.
Medicare .Risk .Adjustment .is .a: .- .correct .answer.Prospective .payment .system
Choose .the .best .medical .record .for .a .RADV .audit .to .include .all .the .diagnoses .in .this
.scenario:• .CMS .is .requesting .diabetes .mellitus .with .neuropathy .to .be .validated• .Assume
.all .the .notes .are .signed .by .the .provider .and .the .diagnoses .are .supported .by .the
.documentation .- .correct .answer.Chart .#2: .DOS .4/2/20XX—Diagnoses: .DM .with
.neurologic .manifestations, .polyneuropathy, .CKD
Which .statement .is .TRUE .regarding .RADV .audits? .- .correct .answer.The .purpose .is .to
.validate .submitted .HCC .data
During .a .retrospective .chart .audit .for .a .XYZ .Medicare .Advantage .Company, .it .is
.determined .a .diagnosis .submitted .is .not .supported .by .medical .record. .There .is .no
.additional .information .to .validate .the .diagnosis. .The .member .is .part .of .a .health .plan .that
.has .1,500 .members .and .the .insurance .company .received .$350 .for .this .diagnosis. .This
