Question 1
Which provider is NOT an approved provider for diagnosis code capture under the HCC
model?
A. LCSW
B. CRNA
C. Podiatrist
D. Registered nurse
CORRECT ANSWER
D. Registered nurse
Question 2
Which element would NOT be taken into consideration for predictive modeling in risk
adjustment?
A. The number of years a patient has been covered under Medicare Advantage
B. Gender
C. Procedure codes
D. Place of service
CORRECT ANSWER
A. The number of years a patient has been covered under Medicare Advantage
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,Question 3
Which medical record(s) can be submitted for HCC validation?
I. Physician office progress note
II. Outpatient Hospital
III. Critical Access Hospital
IV. Laboratory test results
V. Diagnostic X-rays
A. I, II, and III
B. IV
C. I, II, III, and IV
D. I, II, III, IV, and V
CORRECT ANSWER
A. I, II, and III
Question 4
Which statement is coded as a history of condition?
A. Patient presents with a history of colon cancer. He is currently getting chemotherapy
administered by his oncologist.
B. Patient has a history of osteoarthritis currently taking celebrex.
C. Patient presents with CHF complaining of shortness of breath.
D. Patient has a history of breast cancer and sees her oncologist routinely.
CORRECT ANSWER
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, D. Patient has a history of breast cancer and sees her oncologist routinely.
Question 5
Which of the following general statements is NOT TRUE regarding Risk Adjustment
practices and Star Quality Ratings?
A. Health Care Plans with Four Star Quality Ratings can still improve their STARS score
because the highest rating is a Five
B. From a data discovery perspective, risk adjustment and quality measures are inseparable
C. Prospective members can review Medicare Advantage plans' Star Quality rating prior to
enrollment
D. Quality Measures like Star Ratings and HEDIS have no correlation with the medical record
information that is collected in support of risk adjustment
CORRECT ANSWER
B. From a data discovery perspective, risk adjustment and quality measures are
inseparable
Question 6
Which risk adjustment model is used by Medicaid programs?
A. HCC
B. CDPS
C. ZIPC
D. MIPS
CORRECT ANSWER
B. CDPS
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Which provider is NOT an approved provider for diagnosis code capture under the HCC
model?
A. LCSW
B. CRNA
C. Podiatrist
D. Registered nurse
CORRECT ANSWER
D. Registered nurse
Question 2
Which element would NOT be taken into consideration for predictive modeling in risk
adjustment?
A. The number of years a patient has been covered under Medicare Advantage
B. Gender
C. Procedure codes
D. Place of service
CORRECT ANSWER
A. The number of years a patient has been covered under Medicare Advantage
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,Question 3
Which medical record(s) can be submitted for HCC validation?
I. Physician office progress note
II. Outpatient Hospital
III. Critical Access Hospital
IV. Laboratory test results
V. Diagnostic X-rays
A. I, II, and III
B. IV
C. I, II, III, and IV
D. I, II, III, IV, and V
CORRECT ANSWER
A. I, II, and III
Question 4
Which statement is coded as a history of condition?
A. Patient presents with a history of colon cancer. He is currently getting chemotherapy
administered by his oncologist.
B. Patient has a history of osteoarthritis currently taking celebrex.
C. Patient presents with CHF complaining of shortness of breath.
D. Patient has a history of breast cancer and sees her oncologist routinely.
CORRECT ANSWER
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, D. Patient has a history of breast cancer and sees her oncologist routinely.
Question 5
Which of the following general statements is NOT TRUE regarding Risk Adjustment
practices and Star Quality Ratings?
A. Health Care Plans with Four Star Quality Ratings can still improve their STARS score
because the highest rating is a Five
B. From a data discovery perspective, risk adjustment and quality measures are inseparable
C. Prospective members can review Medicare Advantage plans' Star Quality rating prior to
enrollment
D. Quality Measures like Star Ratings and HEDIS have no correlation with the medical record
information that is collected in support of risk adjustment
CORRECT ANSWER
B. From a data discovery perspective, risk adjustment and quality measures are
inseparable
Question 6
Which risk adjustment model is used by Medicaid programs?
A. HCC
B. CDPS
C. ZIPC
D. MIPS
CORRECT ANSWER
B. CDPS
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