CRC EXAM QUESTIONS WITH COMPLETE
SOLUTIONS
1 star Correct Answers Poor Performance
2 star Correct Answers Below average performance
3 star Correct Answers average performance
4 star Correct Answers Above Average Performance
5 star Correct Answers Excellent performance
81 HEDIS Measures DIVIDED into five domains of care
Correct Answers 1. Effectiveness of Care
2. Access/Availability of Care
3. Experience of Care
4. Utilization and relative resource use
5. Health Plan Descriptive Information
Accountable care Oganization three core principles Correct
Answers 1. they are provider=led organizations with a strong
base of primary care that are collectively accountable for quality
and total per capita across the continuum of care for a
population of patients, with
2. payments that are linked to quality improvements that also
reduce overall costs and use
3. Reliabloe and progressively more sophisticated performance
measurements to support improvement, and provide confidence
that savings are achieved through improvements in care
, ACO Can choose one of two payment models (one sided or two
sided) Correct Answers one sided ACO participate in shared
savings for the first two years and assume shared losses in
addition to the shared savings for the third year maxium sharing
rate of 50%
ACO Two sided payment Correct Answers Providers will
assume some financial risk, but will be able to share in any
savings that occur (no 2% benchmark before provider savings
accrue)
Annual RA Audits Correct Answers CMS conducts audits of
the risk adjustment data submitted by or on behalf of health
plans to ensure program integrity
code a proper vascular ulcer Correct Answers must have the
location and type
Concurrent reviews Correct Answers performed ongoing as
patients are seen prior to reporting and in risk adjustment the
current year
Differences between the CMS RADV and HHS HRADV
Correct Answers CMS RADV allows for any face to face
encounter by an approved provider to be subitted for audit
support while HHC HRADV only allows DOS that were
submitted on t he edge server.
Differences between the CMS RADV AND HHS HRADV
Correct Answers cms RADV is typically 2-3 years after
SOLUTIONS
1 star Correct Answers Poor Performance
2 star Correct Answers Below average performance
3 star Correct Answers average performance
4 star Correct Answers Above Average Performance
5 star Correct Answers Excellent performance
81 HEDIS Measures DIVIDED into five domains of care
Correct Answers 1. Effectiveness of Care
2. Access/Availability of Care
3. Experience of Care
4. Utilization and relative resource use
5. Health Plan Descriptive Information
Accountable care Oganization three core principles Correct
Answers 1. they are provider=led organizations with a strong
base of primary care that are collectively accountable for quality
and total per capita across the continuum of care for a
population of patients, with
2. payments that are linked to quality improvements that also
reduce overall costs and use
3. Reliabloe and progressively more sophisticated performance
measurements to support improvement, and provide confidence
that savings are achieved through improvements in care
, ACO Can choose one of two payment models (one sided or two
sided) Correct Answers one sided ACO participate in shared
savings for the first two years and assume shared losses in
addition to the shared savings for the third year maxium sharing
rate of 50%
ACO Two sided payment Correct Answers Providers will
assume some financial risk, but will be able to share in any
savings that occur (no 2% benchmark before provider savings
accrue)
Annual RA Audits Correct Answers CMS conducts audits of
the risk adjustment data submitted by or on behalf of health
plans to ensure program integrity
code a proper vascular ulcer Correct Answers must have the
location and type
Concurrent reviews Correct Answers performed ongoing as
patients are seen prior to reporting and in risk adjustment the
current year
Differences between the CMS RADV and HHS HRADV
Correct Answers CMS RADV allows for any face to face
encounter by an approved provider to be subitted for audit
support while HHC HRADV only allows DOS that were
submitted on t he edge server.
Differences between the CMS RADV AND HHS HRADV
Correct Answers cms RADV is typically 2-3 years after
