CRC Exam Exam 100% VERIFIED ANSWERS
LATEST UPDATES
How is predictive modeling used in risk adjustment? - 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 - 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 - 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 - ANSWER>>a. Outcomes
How often are HEDIS measures revised?
,a. As needed
b. Monthly
c. Bi-annually
d. Annually - 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. - 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 - 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 - 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 - 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.
c. An average of costs associated with diagnoses used to determine which
providers to contract with for a health plan.
d. An average payment associated with diagnoses used to determine which
health plans providers should contract with. - ANSWER>>a. An analytical review
of known data elements to establish a hypothesis related to the future health of
patients.
Who developed and maintains HEDIS?
a. CMS
b. OIG
c. BCBS
, d. NCQA - ANSWER>>d. NCQA
What do the Star Ratings identify?
a. Top performing health plans based on quality
b. Top performing doctors based on quality
c. Cost of healthcare in facilities
d. Cost of healthcare by provider - ANSWER>>a. Top performing health plans
based on quality
What is the goal of HEDIS?
a. Allow for patients to rate their physicians.
b. Allow patients to compare health plans.
c. Allow patients to schedule appointments online.
d. Allow patients to access their medical records. - ANSWER>>b. Allow patients
to compare health plans.
When are Star Ratings are publicly published?
a. January of each year.
b. January and June of each year.
c. October of each year.
d. April and October of each year - ANSWER>>c. October of each year.
How is predictive modeling used in risk adjustment?
a. Determine the RAF score in HCC compared to FFS.
b. Determine suspected diagnoses based on data elements.
c. Determine the correct enrollment process.
d. Determine the return on investment for hiring coders. - ANSWER>>b.
Determine suspected diagnoses based on data elements.
If you were using predictive modeling and the results were:
• Rx Claim: Albuterol (quick-relief inhaler)
• Medical Claim: Pulmonary Function Test
• DME claim: Home Nebulizer
LATEST UPDATES
How is predictive modeling used in risk adjustment? - 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 - 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 - 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 - ANSWER>>a. Outcomes
How often are HEDIS measures revised?
,a. As needed
b. Monthly
c. Bi-annually
d. Annually - 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. - 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 - 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 - 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 - 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.
c. An average of costs associated with diagnoses used to determine which
providers to contract with for a health plan.
d. An average payment associated with diagnoses used to determine which
health plans providers should contract with. - ANSWER>>a. An analytical review
of known data elements to establish a hypothesis related to the future health of
patients.
Who developed and maintains HEDIS?
a. CMS
b. OIG
c. BCBS
, d. NCQA - ANSWER>>d. NCQA
What do the Star Ratings identify?
a. Top performing health plans based on quality
b. Top performing doctors based on quality
c. Cost of healthcare in facilities
d. Cost of healthcare by provider - ANSWER>>a. Top performing health plans
based on quality
What is the goal of HEDIS?
a. Allow for patients to rate their physicians.
b. Allow patients to compare health plans.
c. Allow patients to schedule appointments online.
d. Allow patients to access their medical records. - ANSWER>>b. Allow patients
to compare health plans.
When are Star Ratings are publicly published?
a. January of each year.
b. January and June of each year.
c. October of each year.
d. April and October of each year - ANSWER>>c. October of each year.
How is predictive modeling used in risk adjustment?
a. Determine the RAF score in HCC compared to FFS.
b. Determine suspected diagnoses based on data elements.
c. Determine the correct enrollment process.
d. Determine the return on investment for hiring coders. - ANSWER>>b.
Determine suspected diagnoses based on data elements.
If you were using predictive modeling and the results were:
• Rx Claim: Albuterol (quick-relief inhaler)
• Medical Claim: Pulmonary Function Test
• DME claim: Home Nebulizer
