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Which of the following medications are prescribed to cancer patients to eradicate the cancer or for
prophylaxis?
I. Tamoxifen
II. Anastrozole
III. Januvia
IV. Crestor
A. I and II
B. I and III
C. II and III
D. I, II, III and IV ✔Correct Answer-A
Anastrozole is used to treat breast cancer in women who have gone through menopause. It works by
lowering estrogen hormone levels to help shrink tumors and slow their growth. Tamoxifen is
prescribed for women who have breast cancer with tumors fueled by estrogen. The medication
blocks the action of estrogen.
The definition of a best medical record for a RADV audit is:
A. Documentation validates the CMS requested HCCs, contains all the necessary documentation
elements and has an additional HCC not requested by CMS
B. Documentation that validates all the requested HCCs
C. Documentation that validates the requested HCC, but there is no provider signature
D. Documentation that validates the requested HCC plus validates an additional HCC, contains all the
necessary documentation elements, but is missing the provider signature, for which a signed CMS
attestation was provided but not signed by the provider ✔Correct Answer-A
RADV guidelines state that the Best Medical Record contains documentation that supports HCC and
all elements of proper documentation are followed, for example, signed by provider. Proper
documentation is the first aspect that must be reviewed to determine if the record could be
considered a Best Medical Record. After proper documentation is determined, the additional HCC
(which can decrease the amount owed to CMS) within the note makes this the Best Medical Record.
Which of the following are reported by a provider for beneficiaries in a Medicare Advantage Plan?
I. Nature of the presenting problem
II. Resolved conditions that have been treated in the past
III. Family history for all conditions
IV. All chronic conditions
A. I
B. II and III
C. I and IV
D. I, II, III and IV ✔Correct Answer-C
Providers must report all diagnoses that affect the patient's evaluation, care, and treatment,
including: Nature of the presenting problem All chronic conditions (such as atrial fibrillation,
congestive heart failure (CHF), chronic kidney disease (CKD), rheumatoid arthritis, diabetes with
manifestations, chronic obstruction pulmonary disease (COPD), all active cancers) History on any
relevant past conditions ZV-codes (factors that influence health/status codes) E-codes (external
causes of injury and poisoning, and certain other consequences of external causes) HCC scores on
, individual members determine CMS reimbursement to the plan. Diagnosis and demographic
information should be captured at each face-to-face encounter to obtain a health-based measure of
that member's future medical needs.
Which of the following records would be a good source for a retrospective chart audit?
A. DME documentation
B. Cardiologist records
C. Dietician notes
D. RN notes ✔Correct Answer-B
A cardiologist is the only approved provider provided as an answer option according to CMS for Risk
Adjustment
Retrospective audits should include the following attributes:
I. Provider signatures
II. Supporting documentation of the patient's diagnoses
III. DOS
A. I
B. II
C. I and II
D. I, II and III ✔Correct Answer-D
Which type of audit evaluates appropriate risk scores of patients?
A. ZPIC
B. RADV
C. RAC
D. CERT ✔Correct Answer-B
RADV (Risk Adjustment Data Validation) and IVA (Independent Validation Audit) are audits used in
risk adjustment models to verify submitted diagnoses of patients.
What information is required when submitting documentation to support a diagnosis for a
RADV/IVA?
A. All patient records for the calendar year resulting in care for a chronic condition
B. All inpatient hospital records where a readmission occurred
C. A single DOS for outpatient records and the full inpatient set for hospital records
D. All professional provider documentation for the previous year ✔Correct Answer-C
When submitting documentation for a RADV/IVA, the submission should be the single date of service
for physician and other outpatient records, and the full hospital record from admission to discharge
for inpatient records supporting a diagnosis.
What is TRUE regarding the code assignment requirement for chronic kidney disease requiring
dialysis (N18.6)?
A. The diagnosis should only be reported when the patient is admitted to the hospital.
B. The diagnosis should only be reported when the patient is diagnosed with CKD and is actively
being treated by a specialist.
C. The patient should be diagnosed with CKD and is on chronic dialysis or receiving kidney
transplants are associated with this diagnosis.
D. The diagnosis should only be reported when the patient is diagnosed with chronic renal
insufficiency. ✔Correct Answer-C