HCC Coding/Risk Adjustment Exam 2026 With
100% Accurate Answers
Risk Adjustment Model - Precise Answer ✔✔Calculates risk scores for all beneficiaries with
available data
What are the three submission deadlines? - Precise Answer ✔✔1. First Friday in September =
Initial Risk Score
2. First Friday in March = Mid-year Update
3. January 31 after the payment year = Final reconcilation
Medicare risk adjustment model is prospective. This means? - Precise Answer ✔✔ Diagnoses
reported in the prior year and demographic information are utilized to "predict" future costs
and adjust payments accordingly
Risk Scores. - Precise Answer✔✔ Measures individual beneficiaries' relative risk and are used
to adjust payments for each beneficiary's expected expenditures.
FERAS Response Report. - Precise Answer ✔✔Rejected data after it has been processed
through FERAS is recorded in this report.
RAPS Return File - Precise Answer ✔✔This is a daily report that shows all records approved
and where errors occurred.
,RAPS Transaction Error Report - Precise Answer ✔✔Displays records on which errors
occurred.
RAPS Transaction Summary Report - Precise Answer ✔✔A report sent to the MA organization
daily and identifies data that have been finalized in RAPS database
Duplicate Diagnosis Cluster Report - Precise Answer ✔✔Shows diagnosis clusters submitted
with information that duplicates a stored cluster.
RAPS Monthly Plan Activity Report and Cumulative Plan Activity Report - Precise Answer
✔✔Provides a summary of all diagnoses stored for a given time period.
Error Frequency Report - Precise Answer ✔✔This report is distributed monthly and quarterly.
Provides an overview of all errors associated with files submitted in test and production.
RAPS database - Precise Answer ✔✔Stores all finalized diagnosis clusters
Risk Adjustment System (RAS) - Precise Answer ✔✔Executes the risk adjustment model and
calculates the risk score using the SAS model.
Medicare Advantage Prescription Drug System (MARx) - Precise Answer ✔✔
Processes
payments to plans and issues the MMR (Monthly Membership Report) and MOR (Model
Output Report).
How often does CMS conduct data validation audits and for what purpose? - Precise Answer
✔✔Audits are done annually on selected plans that may have to request medical record
documentation from the providers to support the submitted diagnoses.
What types of data are checked in FERAS? - Precise Answer ✔✔File-level, batch-level and
first and last detailed records
, RAPS Return file - Precise Answer ✔✔Daily reports that shows all records approved and
where errors occurred.
What does File-level information identified? - Precise Answer ✔✔Submitter
What does Batch-level information identify? - Precise Answer ✔✔MA organization
What does Detail-level information identify? - Precise Answer ✔✔Beneficiary
Define Reconciliation - Precise Answer ✔✔ The completion of the implementation of
payments with CMS calculating final risk adjustment factors and beneficiary stats based on
complete data. Necessary adjustments for institutional status and demographic data for
enrollees is considered.
CMS continues to allow a period (approximately 13 months after the data collection year) for
submitting final RAPS data for the appropriate data collection period.
Is this condition a Probably Forever/Almost ALLS (still has condition even though mediation
or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
Septicemia (Category 380) - Precise Answer ✔✔Probably Forever/Almost ALLS
Is this condition a Probably Forever/Almost ALLS (still has condition even though mediation
or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
Heart Failure (Category 428) - Precise Answer ✔✔Probably Forever/Almost ALLS
100% Accurate Answers
Risk Adjustment Model - Precise Answer ✔✔Calculates risk scores for all beneficiaries with
available data
What are the three submission deadlines? - Precise Answer ✔✔1. First Friday in September =
Initial Risk Score
2. First Friday in March = Mid-year Update
3. January 31 after the payment year = Final reconcilation
Medicare risk adjustment model is prospective. This means? - Precise Answer ✔✔ Diagnoses
reported in the prior year and demographic information are utilized to "predict" future costs
and adjust payments accordingly
Risk Scores. - Precise Answer✔✔ Measures individual beneficiaries' relative risk and are used
to adjust payments for each beneficiary's expected expenditures.
FERAS Response Report. - Precise Answer ✔✔Rejected data after it has been processed
through FERAS is recorded in this report.
RAPS Return File - Precise Answer ✔✔This is a daily report that shows all records approved
and where errors occurred.
,RAPS Transaction Error Report - Precise Answer ✔✔Displays records on which errors
occurred.
RAPS Transaction Summary Report - Precise Answer ✔✔A report sent to the MA organization
daily and identifies data that have been finalized in RAPS database
Duplicate Diagnosis Cluster Report - Precise Answer ✔✔Shows diagnosis clusters submitted
with information that duplicates a stored cluster.
RAPS Monthly Plan Activity Report and Cumulative Plan Activity Report - Precise Answer
✔✔Provides a summary of all diagnoses stored for a given time period.
Error Frequency Report - Precise Answer ✔✔This report is distributed monthly and quarterly.
Provides an overview of all errors associated with files submitted in test and production.
RAPS database - Precise Answer ✔✔Stores all finalized diagnosis clusters
Risk Adjustment System (RAS) - Precise Answer ✔✔Executes the risk adjustment model and
calculates the risk score using the SAS model.
Medicare Advantage Prescription Drug System (MARx) - Precise Answer ✔✔
Processes
payments to plans and issues the MMR (Monthly Membership Report) and MOR (Model
Output Report).
How often does CMS conduct data validation audits and for what purpose? - Precise Answer
✔✔Audits are done annually on selected plans that may have to request medical record
documentation from the providers to support the submitted diagnoses.
What types of data are checked in FERAS? - Precise Answer ✔✔File-level, batch-level and
first and last detailed records
, RAPS Return file - Precise Answer ✔✔Daily reports that shows all records approved and
where errors occurred.
What does File-level information identified? - Precise Answer ✔✔Submitter
What does Batch-level information identify? - Precise Answer ✔✔MA organization
What does Detail-level information identify? - Precise Answer ✔✔Beneficiary
Define Reconciliation - Precise Answer ✔✔ The completion of the implementation of
payments with CMS calculating final risk adjustment factors and beneficiary stats based on
complete data. Necessary adjustments for institutional status and demographic data for
enrollees is considered.
CMS continues to allow a period (approximately 13 months after the data collection year) for
submitting final RAPS data for the appropriate data collection period.
Is this condition a Probably Forever/Almost ALLS (still has condition even though mediation
or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
Septicemia (Category 380) - Precise Answer ✔✔Probably Forever/Almost ALLS
Is this condition a Probably Forever/Almost ALLS (still has condition even though mediation
or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
Heart Failure (Category 428) - Precise Answer ✔✔Probably Forever/Almost ALLS
