CRC Practice Exam C with all Correct & 100% Verified
Answers |Latest Version |Already Graded A+
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 considerationII. No, CMS will treat all diagnosis with
the same financial weightIII. Yes, CMS will accept a lower or higher HCC to validate an HCC within the
same categoryIV. 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
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 codesII. Provides opportunities to compare claims data to the documentation and submit
deletions if the documentation does not support what was on the claimIII. 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
Which one 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 patients with DM and CKD as a diabetic manifestation. ✔Correct
Answer-A
What payment system does Medicare Risk Adjustment represent?
A. Prospective payment system
B. Retrospective payment system
C. Fee-for-service payment system
D. Case rate payment system ✔Correct Answer-A
Which medical record (chart) is best for a RADV audit to include all the diagnoses?
• 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, polyneuropathy
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
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 doesn't create a special cover page for each patient being audited ✔Correct Answer-B
What are the differences between a CMS RADV (Medicare Advantage) and an HHS RADV
(commercial risk adjustment)?
I. CMS RADV is typically two to three years after payment, while HHS RADV occurs typically six
months after year-end.
II. CMS RADV involves choosing health plans by random sampling or targeting efforts, while HHS
RADV is an annual requirement of all plans
III. CMS RADV allows any face-to-face encounter for audit support, while HHS RADV allows only those
DOS that were submitted on the Edge server with an exception to allow encounters that would
normally be accepted on the Edge server.
IV. CMS RADV uses a stratified sample of three strata while HHS RADV uses 10 strata
A. I and II
B. I, II, and III
C. I and III
D. All are differences between CMS RADV and HHS RADV ✔Correct Answer-D
In order for a MA Plan to improve their revenue, which statement describes the correct approach a
plan should take to accomplish this?
A. Code all diagnoses listed in the patient's problem list
B. Develop a prospective and retrospective review to capture all accurate diagnoses
C. Target diagnosis code selection for the highest diagnoses which yield more reimbursement
D. Transfer healthy patients out of the network and focus on treating patients with chronic conditions
✔Correct Answer-B
When is it appropriate to use history of malignancy, from category Z85?
A. Once the malignancy is removed from that site
B. When the patient cancels treatment for that site
C. It has been excised and no further treatment directed to the site
D. When the patient has a lapse in treatment ✔Correct Answer-C
Patient is admitted to the hospital with streptococcal sepsis which has caused pneumonia. What ICD-
10-CM coding should be reported?
A. A49.1, T81.40XA
B. A40.9, J15.4
C. A40.9
D. A49.1, J18.9 ✔Correct Answer-B
A 70-year-old with COPD is admitted to the hospital for acute exacerbation of chronic bronchial
asthma. What ICD-10-CM coding should be reported?
A. J44.1
B. J45.901, J44.9
C. J45.901
D. J44.1, J45.901 ✔Correct Answer-D
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?
A. I25.110
B. I25.810
C. I25.790
Answers |Latest Version |Already Graded A+
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 considerationII. No, CMS will treat all diagnosis with
the same financial weightIII. Yes, CMS will accept a lower or higher HCC to validate an HCC within the
same categoryIV. 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
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 codesII. Provides opportunities to compare claims data to the documentation and submit
deletions if the documentation does not support what was on the claimIII. 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
Which one 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 patients with DM and CKD as a diabetic manifestation. ✔Correct
Answer-A
What payment system does Medicare Risk Adjustment represent?
A. Prospective payment system
B. Retrospective payment system
C. Fee-for-service payment system
D. Case rate payment system ✔Correct Answer-A
Which medical record (chart) is best for a RADV audit to include all the diagnoses?
• 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, polyneuropathy
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
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 doesn't create a special cover page for each patient being audited ✔Correct Answer-B
What are the differences between a CMS RADV (Medicare Advantage) and an HHS RADV
(commercial risk adjustment)?
I. CMS RADV is typically two to three years after payment, while HHS RADV occurs typically six
months after year-end.
II. CMS RADV involves choosing health plans by random sampling or targeting efforts, while HHS
RADV is an annual requirement of all plans
III. CMS RADV allows any face-to-face encounter for audit support, while HHS RADV allows only those
DOS that were submitted on the Edge server with an exception to allow encounters that would
normally be accepted on the Edge server.
IV. CMS RADV uses a stratified sample of three strata while HHS RADV uses 10 strata
A. I and II
B. I, II, and III
C. I and III
D. All are differences between CMS RADV and HHS RADV ✔Correct Answer-D
In order for a MA Plan to improve their revenue, which statement describes the correct approach a
plan should take to accomplish this?
A. Code all diagnoses listed in the patient's problem list
B. Develop a prospective and retrospective review to capture all accurate diagnoses
C. Target diagnosis code selection for the highest diagnoses which yield more reimbursement
D. Transfer healthy patients out of the network and focus on treating patients with chronic conditions
✔Correct Answer-B
When is it appropriate to use history of malignancy, from category Z85?
A. Once the malignancy is removed from that site
B. When the patient cancels treatment for that site
C. It has been excised and no further treatment directed to the site
D. When the patient has a lapse in treatment ✔Correct Answer-C
Patient is admitted to the hospital with streptococcal sepsis which has caused pneumonia. What ICD-
10-CM coding should be reported?
A. A49.1, T81.40XA
B. A40.9, J15.4
C. A40.9
D. A49.1, J18.9 ✔Correct Answer-B
A 70-year-old with COPD is admitted to the hospital for acute exacerbation of chronic bronchial
asthma. What ICD-10-CM coding should be reported?
A. J44.1
B. J45.901, J44.9
C. J45.901
D. J44.1, J45.901 ✔Correct Answer-D
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?
A. I25.110
B. I25.810
C. I25.790
