1
AAPC - CRC TEST 3 Questions with Answers (100%
Correct Answers)
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
A. I
B. II
C. III
D. III and IV— Answer: D. III and IV
Retrospective audits provide insurance companies with ability to
scrub/correct their data which accomplishes which of the following?
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,2
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
A. I and II
B. I
C. II
D. II and III— Answer: A. I and II
Which of the following is an example of fraud?
A. Reporting a diabetic manifestation to increase the risk score.
B. Submitting a record for a RADV audit which includes diagnoses
that were not previously reported.
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,3
C. Training physicians to document causal relationships for
manifestations for chronic illnesses when present.
D. Setting a policy to report all patient's with DM and CKD as a
diabetic manifestation.— Answer: A. Reporting a diabetic
manifestation to increase the risk score.
Risk Adjustment is a:
A. Prospective payment system
B. Retrospective payment system
C. Fee-for-service payment system
D. Case rate payment system— Answer: A. 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
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, 4
A. Chart #1: DOS 1/1/20XX—Diagnoses: DM, PVD
B. Chart #2: DOS 4/2/20XX—Diagnoses: DM with neurologic
manifestations, polyneuropathy, CKD
C. Chart # 3: DOS 7/7/20XX—Diagnoses: DM with neurologic
manifestations
D. Chart # 4: DOS 9/9/20XX—Diagnosis: DM, HTN— Answer: B. Chart
#2: DOS 4/2/20XX—Diagnoses: DM with neurologic manifestations,
polyneuropathy, CKD
Which statement is TRUE regarding RADV audits?
A. A cover page is not necessary
B. The purpose is to validate submitted HCC data
C. Conducted randomly throughout the year
D. CMS creates a special cover page for each patient being audited—
Answer: B. 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
© 2025 All rights reserved
AAPC - CRC TEST 3 Questions with Answers (100%
Correct Answers)
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
A. I
B. II
C. III
D. III and IV— Answer: D. III and IV
Retrospective audits provide insurance companies with ability to
scrub/correct their data which accomplishes which of the following?
© 2025 All rights reserved
,2
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
A. I and II
B. I
C. II
D. II and III— Answer: A. I and II
Which of the following is an example of fraud?
A. Reporting a diabetic manifestation to increase the risk score.
B. Submitting a record for a RADV audit which includes diagnoses
that were not previously reported.
© 2025 All rights reserved
,3
C. Training physicians to document causal relationships for
manifestations for chronic illnesses when present.
D. Setting a policy to report all patient's with DM and CKD as a
diabetic manifestation.— Answer: A. Reporting a diabetic
manifestation to increase the risk score.
Risk Adjustment is a:
A. Prospective payment system
B. Retrospective payment system
C. Fee-for-service payment system
D. Case rate payment system— Answer: A. 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
© 2025 All rights reserved
, 4
A. Chart #1: DOS 1/1/20XX—Diagnoses: DM, PVD
B. Chart #2: DOS 4/2/20XX—Diagnoses: DM with neurologic
manifestations, polyneuropathy, CKD
C. Chart # 3: DOS 7/7/20XX—Diagnoses: DM with neurologic
manifestations
D. Chart # 4: DOS 9/9/20XX—Diagnosis: DM, HTN— Answer: B. Chart
#2: DOS 4/2/20XX—Diagnoses: DM with neurologic manifestations,
polyneuropathy, CKD
Which statement is TRUE regarding RADV audits?
A. A cover page is not necessary
B. The purpose is to validate submitted HCC data
C. Conducted randomly throughout the year
D. CMS creates a special cover page for each patient being audited—
Answer: B. 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
© 2025 All rights reserved
