AAPC - CRC TEST 3 EXAM QUESTIONS AND 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 - CORRECT ANSWER✅✅D. 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
A. I and II
B. I
C. II
D. II and III - CORRECT 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.
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. - CORRECT
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 - CORRECT 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
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 - CORRECT 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 - CORRECT 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
diagnosis. The member is part of a health plan that has 1,500 members and the insurance company
received $350 for this diagnosis. This HCC is chosen for a RADV audit. Using the CMS extrapolation
methodology, how much could the company have saved if it deleted this code during the retrospective
chart audit process?
A. $1,500
B. $350
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 - CORRECT ANSWER✅✅D. 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
A. I and II
B. I
C. II
D. II and III - CORRECT 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.
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. - CORRECT
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 - CORRECT 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
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 - CORRECT 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 - CORRECT 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
diagnosis. The member is part of a health plan that has 1,500 members and the insurance company
received $350 for this diagnosis. This HCC is chosen for a RADV audit. Using the CMS extrapolation
methodology, how much could the company have saved if it deleted this code during the retrospective
chart audit process?
A. $1,500
B. $350
