AAPC CRC EXAM REVIEW LATEST 2025
TEST WITH COMPLETE QUESTIONS AND
CORRECT ANSWERS RATED A+
what is predictive modeling in risk adjustment Correct Answer an
analytical review of known data elements to establish a
hypothesis related to the future needs of patients
data elements used for predictive modeling include
I - claims data
II - prescription drug events
III - procedures coded
IV - durable medical équipement Correct Answer I, II, III, IV
if you were using predictive modeling and the results were:
-the member had a DME claim for oxygen
-the member had an rx claim for pulmicort flehaler
-the member had a medical claim which included airway
obstruction treatment
what diagnosis would you predict this member had Correct
Answer COPD
in the medical record review, the dr has documentation in a single
encounter of an eye exam, a BUN test, and HbA1c testing. which
area of HEDIS measures are most likely satisfied in this
encounter Correct Answer diabetic care
which statements are TRUE regarding HEDIS
,I - HEDIS was designed to allow consumers to compare health
plan performance to national or regional benchmarks
II - HEDIS results are used to track year-to-year performances
III - HEDIS was developed and is maintained by NCQA
IV - CMS requires HMOs to submit Medicare HEDIS data to be a
Medicare Advantage Organization Correct Answer I, II, III, IV
how is HEDIS data collected
I - insurance claims
II - surveys
III - medical chart reviews
IV - provider reporting Correct Answer II, III, IV
which of the following are considered collection types for Merit-
based incentive payment system (MIPS) data
I - administrative measures
II - qualified clinical data registry (QCDR)
III - MIPS clinical quality measures (CQMs)
IV - electronic clinical quality measures (eCOMs)
V - medicare part b claims measures
VI - consumer assessment of healthcare providers & systems
(CAHPS) for MIPS survey
VII - CMS web interface measures Correct Answer I, IV, V, VII
which MIPS performance category promotes the secure
exchange of health information and the use of certified electronic
health record technology (CEHRT) for coordination of care
Correct Answer promoting interoperability
what is an alternative payment model (APM) Correct Answer a
group of clinicians who have created a medicare advantage
organization that utilizes only providers affiliated with their group
, for a RADV audit, which records are sent from the health plan to
CMS Correct Answer the 5 best records to support the diagnosis
submitted for that beneficiary
true or false: many diagnoses are missed in physician coding
because diagnoses are reported from the assessment portion of a
visit instead of throughout the medical record for that visit Correct
Answer true
which medicare part is reimbursed based on the risk adjustment
models Correct Answer part c
who typically employs risk adjustment coders Correct Answer
health plans
is a health plan required to follow the minimum necessary rule
Correct Answer yes, health plans are covered entities and are
therefore required to follow the minimum necessary rule
what is an example of fraud Correct Answer reporting a diagnosis
or co-morbidity that does not exist to obtain higher reimbursement
which part of medicare is also called medicare advantage Correct
Answer part c
which health insurance assistance program is sponsored by
federal and state governments Correct Answer medicaid
what OIG document should a medicare advantage participant
review for potential problem areas that will receive special
scrutiny in the upcoming year Correct Answer OIG work plan
which code set is used by risk adjustment coders Correct Answer
icd-10-cm
TEST WITH COMPLETE QUESTIONS AND
CORRECT ANSWERS RATED A+
what is predictive modeling in risk adjustment Correct Answer an
analytical review of known data elements to establish a
hypothesis related to the future needs of patients
data elements used for predictive modeling include
I - claims data
II - prescription drug events
III - procedures coded
IV - durable medical équipement Correct Answer I, II, III, IV
if you were using predictive modeling and the results were:
-the member had a DME claim for oxygen
-the member had an rx claim for pulmicort flehaler
-the member had a medical claim which included airway
obstruction treatment
what diagnosis would you predict this member had Correct
Answer COPD
in the medical record review, the dr has documentation in a single
encounter of an eye exam, a BUN test, and HbA1c testing. which
area of HEDIS measures are most likely satisfied in this
encounter Correct Answer diabetic care
which statements are TRUE regarding HEDIS
,I - HEDIS was designed to allow consumers to compare health
plan performance to national or regional benchmarks
II - HEDIS results are used to track year-to-year performances
III - HEDIS was developed and is maintained by NCQA
IV - CMS requires HMOs to submit Medicare HEDIS data to be a
Medicare Advantage Organization Correct Answer I, II, III, IV
how is HEDIS data collected
I - insurance claims
II - surveys
III - medical chart reviews
IV - provider reporting Correct Answer II, III, IV
which of the following are considered collection types for Merit-
based incentive payment system (MIPS) data
I - administrative measures
II - qualified clinical data registry (QCDR)
III - MIPS clinical quality measures (CQMs)
IV - electronic clinical quality measures (eCOMs)
V - medicare part b claims measures
VI - consumer assessment of healthcare providers & systems
(CAHPS) for MIPS survey
VII - CMS web interface measures Correct Answer I, IV, V, VII
which MIPS performance category promotes the secure
exchange of health information and the use of certified electronic
health record technology (CEHRT) for coordination of care
Correct Answer promoting interoperability
what is an alternative payment model (APM) Correct Answer a
group of clinicians who have created a medicare advantage
organization that utilizes only providers affiliated with their group
, for a RADV audit, which records are sent from the health plan to
CMS Correct Answer the 5 best records to support the diagnosis
submitted for that beneficiary
true or false: many diagnoses are missed in physician coding
because diagnoses are reported from the assessment portion of a
visit instead of throughout the medical record for that visit Correct
Answer true
which medicare part is reimbursed based on the risk adjustment
models Correct Answer part c
who typically employs risk adjustment coders Correct Answer
health plans
is a health plan required to follow the minimum necessary rule
Correct Answer yes, health plans are covered entities and are
therefore required to follow the minimum necessary rule
what is an example of fraud Correct Answer reporting a diagnosis
or co-morbidity that does not exist to obtain higher reimbursement
which part of medicare is also called medicare advantage Correct
Answer part c
which health insurance assistance program is sponsored by
federal and state governments Correct Answer medicaid
what OIG document should a medicare advantage participant
review for potential problem areas that will receive special
scrutiny in the upcoming year Correct Answer OIG work plan
which code set is used by risk adjustment coders Correct Answer
icd-10-cm
