AAPC CRC PRACTICE EXAM 1 QUESTIONS AND ANSWERS LATEST VERSION 2025 ALREADY PASSED

AAPC CRC PRACTICE EXAM 1 QUESTIONS AND ANSWERS LATEST VERSION 2025 ALREADY PASSED Which provider is NOT an approved provider for diagnosis code capture under the HCC model? A. LCSW B. CRNA C. Podiatrist D. Registered nurse - Answers D. Registered nurse Which element would NOT be taken into consideration for predictive modeling in risk adjustment? A. The number of years a patient has been covered under Medicare Advantage B. Gender C. Procedure codes D. Place of service - Answers A. The number of years a patient has been covered under Medicare Advantage Which medical record(s) can be submitted for HCC validation? I. Physician office progress note II. Outpatient Hospital III. Critical Access Hospital IV. Laboratory test results V. Diagnostic X-rays A. I, II, and III B. IV C. I, II, III, and IV D. I, II, III, IV, and V - Answers A. I, II, and III Which statement is coded as a history of condition? A. Patient presents with a history of colon cancer. He is currently getting chemotherapy administered by his oncologist. B. Patient has a history of osteoarthritis currently taking celebrex. C. Patient presents with CHF complaining of shortness of breath. D. Patient has a history of breast cancer and sees her oncologist routinely. - Answers D. Patient has a history of breast cancer and sees her oncologist routinely. Which of the following general statements is NOT TRUE regarding Risk Adjustment practices and Star Quality Ratings? A. Health Care Plans with Four Star Quality Ratings can still improve their STARS score because the highest rating is a Five B. From a data discovery perspective, risk adjustment and quality measures are inseparable C. Prospective members can review Medicare Advantage plans' Star Quality rating prior to enrollment D. Quality Measures like Star Ratings and HEDIS have no correlation with the medical record information that is collected in support of risk adjustment - Answers B. From a data discovery perspective, risk adjustment and quality measures are inseparable Which risk adjustment model is used by Medicaid programs? A. HCC B. CDPS C. ZIPC D. MIPS - Answers B. CDPS What does CMS' Star Ratings program monitor? A. Performance of Medicare Advantage plans B. Fraud and abuse C. Adherence to state scope of practice D. Performance of Medicare providers - Answers A. Performance of Medicare Advantage plans Which statement is TRUE regarding hierarchies? A. Used exclusively by CMS for Medicare Advantage plans B. Mandated to be used for all Medicaid payment models C. Utilized by some private payers D. All of the above - Answers C. Utilized by some private payers Which code set is used for HCC coding? I. CPT II. HCPCS Level II III. ICD-10-CM IV. ICD-10-PCS A. III B. III and IV C. I and III D. I, II, III and IV - Answers A. III Data mining is performed for what purpose? A. Identify data that might be related to patient risk scores B. Look for opportunities for clinical staff incentives C. Make sure that low performing providers are penalized for poor outcomes