Risk Adjustment CRC Exam Questions &
Answers – Latest Update 2026 | Exam Prep
PDF | Graded A+
Interactions - correct answerWhat are extra RA values or factors added when a patient
has more than one major significant dx identified in model ?
Quality, Promoting Interoperability, Improvement Activity, Cost - correct answerMIPS
Collection Types Categories
When are Star Ratings publicly published? - correct answerOctober of each year
HEDIS types of collection - correct answerSurveys, Medical Chart Reviews, Insurance
Claims, Medical Office Visits, Procedures
What does Abbreviation MAC stand for? - correct answerMedicare Administrative
Contractor
Each year, Medicare normalizes risk scores to maintain an average of what? - correct
answer1.0
Which type of documentation can be used to support diagnoses reported under risk
adjustment models? - correct answerInpatient admission note
Risk adjustment models are used to: - correct answerDetermine projected costs of
health care based on the condition(s) of patients
When submitting records for RADV audit, will additional current diagnoses that were not
originally reported be considered when documentation is submitted for the audit? -
correct answerYes, additional current diagnoses not included on claims data may be
approved during the audit.
For commercial plans, funding is allocated based on - correct answerCurrent year's
known diagnoses
What is the impact on reimbursement under the risk adjustment model if chronic
conditions are not coded properly? - correct answerFailure to code for a chronic
condition the patient has may result in an inaccurate RAF.
What is the purpose of a RADV - correct answerTo evaluate the appropriateness of risk
scores to patients.
,How many records are submitted by health plans per patient in a RADV audit? - correct
answer5
Each record submitted for a RADV should include: - correct answerI. Complete list and
legible records
2. Credential for the rendering provider
3.Provider signature or attestation
How is predictive modeling used in risk adjustment? - correct answerDetermine
suspected diagnoses based on data elements.
What might happen as a result of predictive modeling? - correct answerDisease
Management Programs
In the CMS Star Ratings program, which measure is given the highest weight? - correct
answerOutcomes
The results of a RADV audit are extrapolated across all members of the plan that was
audited. What does this mean? - correct answerFinancial penalties will be averaged
over the plan membership
Retrospective audits generally include finding additional diagnoses, CMS has stated
that the deletion of conditions needs to be part of these audits; why is it so hard for
companies to follow CMS directives? - correct answer1. There is a potential of loss of
revenue
2. Billing compliance issues might come too light
RADV/IVA audit submissions typically require: - correct answerprovider signature,
credentials, and two patient ID's. The printed provider name is only necessary when the
signature is illegible and there is a need to identify the provider.
Which statements are TRUE regarding retrospective audits? - correct answer1.Can be
performed by internal employees.
2.Can be performed by external consultants who sign a business agreement
3. Performed after data was submitted
If a medical record has conflicting information documented, how is it resolved? - correct
answerprovider is queried and an addendum/late entry is created to address the
conflicting information.
Patient diagnosed with severe protein calorie malnutrition. What is the appropriate
diagnosis coding? - correct answerE43
Which ICD-10-CM code(s) is/are reported when the provider diagnoses the patient with
adult attention deficit disorder (ADD)? - correct answerF98.8
, Patient is being seen in the Outpatient clinic today for liver cancer of a transplanted
liver. Select the correct code(s). - correct answerT86.49, C80.2, C22.8
What is the proper way to code coronary artery disease with no history of prior coronary
artery bypass? - correct answerI25.10
A patient is diagnosed with VAP. Select the diagnosis code(s) - correct answerJ95.851
A 69 year-old male presents for follow up wound care for his bilateral pressure ulcers.
His right heel shows a stage one ulcer and left heel shows a stage two ulcer with dark
scabbing. The provider orders Betadine painting for both ulcers. Assign the correct ICD-
10-CM code(s) for this visit. - correct answerL89.622, L89.611
Patient is seen today for follow up of cirrhosis of the lung found on a thoracic CT. What
ICD-10-CM code is reported? - correct answerJ84.10
Which sentence below, best describes the attributes of an Absence seizure (petit mal)?
- correct answerCharacterized by blank staring and subtle body movements that begin
and end abruptly. It may cause a brief loss of consciousness.
A 67 year-old male is brought in by his daughter for evaluation of two wounds on the
legs. The provider exams the skin and finds two skin ulcers. One ulcer is on the right
calf and the second ulcer is on the left ankle. The provider orders the nurse to clean
both ulcers and for the patient to return in one week. Assign the correct ICD-10-CM
codes for this visit. - correct answerL97.219, L97.329
Which Z code series is used to indicate a lower limb amputation status? - correct
answerZ89
A 62 year-old female with a long standing history of endocrine disease has noticed
numbness in her hands and feet. She sees her physician and after examination, her
provider documents the following:A/P: Polyneuropathy, due to endocrine disease. Will
get new labs and have patient return in four weeks. - correct answer.E34.9, G63
Patient is admitted to the hospital with streptococcal sepsis which has caused
pneumonia. What codes are assigned? - correct answerA40.9, J15.4
70 year-old with COPD is admitted to the hospital for acute exacerbation of chronic
bronchial asthma. What diagnosis code(s) should be reported? - correct answerJ44.1,
J45.901
Patient with coronary arteriosclerosis disease (CAD) sees his cardiologist to discuss a
coronary artery bypass graft (CABG). This would be the patient's first CABG. What ICD-
10-CM code should be reported? - correct answerI25.10 Because Patient was there
only to discuss the CABG
Answers – Latest Update 2026 | Exam Prep
PDF | Graded A+
Interactions - correct answerWhat are extra RA values or factors added when a patient
has more than one major significant dx identified in model ?
Quality, Promoting Interoperability, Improvement Activity, Cost - correct answerMIPS
Collection Types Categories
When are Star Ratings publicly published? - correct answerOctober of each year
HEDIS types of collection - correct answerSurveys, Medical Chart Reviews, Insurance
Claims, Medical Office Visits, Procedures
What does Abbreviation MAC stand for? - correct answerMedicare Administrative
Contractor
Each year, Medicare normalizes risk scores to maintain an average of what? - correct
answer1.0
Which type of documentation can be used to support diagnoses reported under risk
adjustment models? - correct answerInpatient admission note
Risk adjustment models are used to: - correct answerDetermine projected costs of
health care based on the condition(s) of patients
When submitting records for RADV audit, will additional current diagnoses that were not
originally reported be considered when documentation is submitted for the audit? -
correct answerYes, additional current diagnoses not included on claims data may be
approved during the audit.
For commercial plans, funding is allocated based on - correct answerCurrent year's
known diagnoses
What is the impact on reimbursement under the risk adjustment model if chronic
conditions are not coded properly? - correct answerFailure to code for a chronic
condition the patient has may result in an inaccurate RAF.
What is the purpose of a RADV - correct answerTo evaluate the appropriateness of risk
scores to patients.
,How many records are submitted by health plans per patient in a RADV audit? - correct
answer5
Each record submitted for a RADV should include: - correct answerI. Complete list and
legible records
2. Credential for the rendering provider
3.Provider signature or attestation
How is predictive modeling used in risk adjustment? - correct answerDetermine
suspected diagnoses based on data elements.
What might happen as a result of predictive modeling? - correct answerDisease
Management Programs
In the CMS Star Ratings program, which measure is given the highest weight? - correct
answerOutcomes
The results of a RADV audit are extrapolated across all members of the plan that was
audited. What does this mean? - correct answerFinancial penalties will be averaged
over the plan membership
Retrospective audits generally include finding additional diagnoses, CMS has stated
that the deletion of conditions needs to be part of these audits; why is it so hard for
companies to follow CMS directives? - correct answer1. There is a potential of loss of
revenue
2. Billing compliance issues might come too light
RADV/IVA audit submissions typically require: - correct answerprovider signature,
credentials, and two patient ID's. The printed provider name is only necessary when the
signature is illegible and there is a need to identify the provider.
Which statements are TRUE regarding retrospective audits? - correct answer1.Can be
performed by internal employees.
2.Can be performed by external consultants who sign a business agreement
3. Performed after data was submitted
If a medical record has conflicting information documented, how is it resolved? - correct
answerprovider is queried and an addendum/late entry is created to address the
conflicting information.
Patient diagnosed with severe protein calorie malnutrition. What is the appropriate
diagnosis coding? - correct answerE43
Which ICD-10-CM code(s) is/are reported when the provider diagnoses the patient with
adult attention deficit disorder (ADD)? - correct answerF98.8
, Patient is being seen in the Outpatient clinic today for liver cancer of a transplanted
liver. Select the correct code(s). - correct answerT86.49, C80.2, C22.8
What is the proper way to code coronary artery disease with no history of prior coronary
artery bypass? - correct answerI25.10
A patient is diagnosed with VAP. Select the diagnosis code(s) - correct answerJ95.851
A 69 year-old male presents for follow up wound care for his bilateral pressure ulcers.
His right heel shows a stage one ulcer and left heel shows a stage two ulcer with dark
scabbing. The provider orders Betadine painting for both ulcers. Assign the correct ICD-
10-CM code(s) for this visit. - correct answerL89.622, L89.611
Patient is seen today for follow up of cirrhosis of the lung found on a thoracic CT. What
ICD-10-CM code is reported? - correct answerJ84.10
Which sentence below, best describes the attributes of an Absence seizure (petit mal)?
- correct answerCharacterized by blank staring and subtle body movements that begin
and end abruptly. It may cause a brief loss of consciousness.
A 67 year-old male is brought in by his daughter for evaluation of two wounds on the
legs. The provider exams the skin and finds two skin ulcers. One ulcer is on the right
calf and the second ulcer is on the left ankle. The provider orders the nurse to clean
both ulcers and for the patient to return in one week. Assign the correct ICD-10-CM
codes for this visit. - correct answerL97.219, L97.329
Which Z code series is used to indicate a lower limb amputation status? - correct
answerZ89
A 62 year-old female with a long standing history of endocrine disease has noticed
numbness in her hands and feet. She sees her physician and after examination, her
provider documents the following:A/P: Polyneuropathy, due to endocrine disease. Will
get new labs and have patient return in four weeks. - correct answer.E34.9, G63
Patient is admitted to the hospital with streptococcal sepsis which has caused
pneumonia. What codes are assigned? - correct answerA40.9, J15.4
70 year-old with COPD is admitted to the hospital for acute exacerbation of chronic
bronchial asthma. What diagnosis code(s) should be reported? - correct answerJ44.1,
J45.901
Patient with coronary arteriosclerosis disease (CAD) sees his cardiologist to discuss a
coronary artery bypass graft (CABG). This would be the patient's first CABG. What ICD-
10-CM code should be reported? - correct answerI25.10 Because Patient was there
only to discuss the CABG
