CRC EXAM QUESTIONS WITH COMPLETE SOLUTIONS
GUARANTEED PASS BRAND NEW 2025
How is predictive modeling used in risk adjustment? - -
CORRECT ANSWER - >to determine suspected diagnosis based
on data elements.
Which of the following data elements are used in predictive
modeling?
I. DME claims
II. Prescription drug events
III. Physician claims data
IV. Facility claims data
a. III and IV
b. I, II, and IV
c. I, II, and III
d. I, II, III, and IV - - CORRECT ANSWER - >d. I, II, III, and IV
What might happen as a result of predictive
modeling? a. Disease management programs
b. Concurrent audits
c. Transporation benefits
,d. Reduction
in case management - - CORRECT ANSWER - >a.
Disease management programs
In the CMS Star Ratings program, which measure is given the
highest weight?
a. Outcomes
b. Patient experience
c. Customer service
d. Accurate RAF scores - - CORRECT ANSWER - >a. Outcomes
How often are HEDIS measures revised?
a. As needed
b. Monthly
c. Bi-annually
d. Annually - - CORRECT ANSWER - >d. Annually
Which statement is TRUE regarding the CMS Stars quality rating
system?
a. Quality bonus payments are made to physician who score at
least four stars.
b. Quality bonus payments are made to Medicare Advantage
plans who score at least four stars.
c. Quality bonus payments are made to physician who score at
least five stars.
,d. Quality bonus payments are made to Medicare Advantage
plans who score at least five stars. - - CORRECT ANSWER - >b.
Quality bonus payments are made to Medicare Advantage
plans who score at least four stars.
Merit-based Incentive Payment System (MIPS) includes which
performance categories?
I. Promoting Interoperability
II. Cost
III. Improvement Activities
IV. Quantity
V. Quality
a. I and II
b. I, III, and V
c. I, II, III, and V
d. I, II, III, IV, and V - - CORRECT ANSWER - >c. I, II, III, and V
Which of the following are domains in CMS Part C & D Stars
Rating?
I. Staying Healthy
II. Managing Chronic Conditions
III. Member Experience with Health Plans
IV. Member Complaints, Problems Getting Services, and
Improvement in the
, Health Plan's Performance
V. Health Plan Customer Service
a. I, II and III
b. I, III, and V
c. I, II, III, IV and V
d. I, II, III and V - - CORRECT ANSWER - >c. I, II, III, IV and V
What are the participation tracks available through Medicare
Access and CHIP Reauthorization Act (MACRA)?
I. Merit-based Incentive Payment
Systems II. Sustainable Growth
System
III. Advanced Alternative Payment
Models a. I
b. II and III
c. I and III
d. I, II and III - - CORRECT ANSWER - >c. I and III
What is predictive modeling?
a. An analytical review of known data elements to establish a
hypothesis related to the future health of patients.
b. An analytical review of payments to health plans to
determine the cost of future healthcare.
GUARANTEED PASS BRAND NEW 2025
How is predictive modeling used in risk adjustment? - -
CORRECT ANSWER - >to determine suspected diagnosis based
on data elements.
Which of the following data elements are used in predictive
modeling?
I. DME claims
II. Prescription drug events
III. Physician claims data
IV. Facility claims data
a. III and IV
b. I, II, and IV
c. I, II, and III
d. I, II, III, and IV - - CORRECT ANSWER - >d. I, II, III, and IV
What might happen as a result of predictive
modeling? a. Disease management programs
b. Concurrent audits
c. Transporation benefits
,d. Reduction
in case management - - CORRECT ANSWER - >a.
Disease management programs
In the CMS Star Ratings program, which measure is given the
highest weight?
a. Outcomes
b. Patient experience
c. Customer service
d. Accurate RAF scores - - CORRECT ANSWER - >a. Outcomes
How often are HEDIS measures revised?
a. As needed
b. Monthly
c. Bi-annually
d. Annually - - CORRECT ANSWER - >d. Annually
Which statement is TRUE regarding the CMS Stars quality rating
system?
a. Quality bonus payments are made to physician who score at
least four stars.
b. Quality bonus payments are made to Medicare Advantage
plans who score at least four stars.
c. Quality bonus payments are made to physician who score at
least five stars.
,d. Quality bonus payments are made to Medicare Advantage
plans who score at least five stars. - - CORRECT ANSWER - >b.
Quality bonus payments are made to Medicare Advantage
plans who score at least four stars.
Merit-based Incentive Payment System (MIPS) includes which
performance categories?
I. Promoting Interoperability
II. Cost
III. Improvement Activities
IV. Quantity
V. Quality
a. I and II
b. I, III, and V
c. I, II, III, and V
d. I, II, III, IV, and V - - CORRECT ANSWER - >c. I, II, III, and V
Which of the following are domains in CMS Part C & D Stars
Rating?
I. Staying Healthy
II. Managing Chronic Conditions
III. Member Experience with Health Plans
IV. Member Complaints, Problems Getting Services, and
Improvement in the
, Health Plan's Performance
V. Health Plan Customer Service
a. I, II and III
b. I, III, and V
c. I, II, III, IV and V
d. I, II, III and V - - CORRECT ANSWER - >c. I, II, III, IV and V
What are the participation tracks available through Medicare
Access and CHIP Reauthorization Act (MACRA)?
I. Merit-based Incentive Payment
Systems II. Sustainable Growth
System
III. Advanced Alternative Payment
Models a. I
b. II and III
c. I and III
d. I, II and III - - CORRECT ANSWER - >c. I and III
What is predictive modeling?
a. An analytical review of known data elements to establish a
hypothesis related to the future health of patients.
b. An analytical review of payments to health plans to
determine the cost of future healthcare.
