Risk Adjustment CRC Exam Questions
With Correct Answers 2024
What .are .extra .RA .values .or .factors .added .when .a .patient .has .more .than .one .major
.significant .dx .identified .in .model .? .- .correct .answer.Interactions
MIPS .Collection .Types .Categories .- .correct .answer.Quality, .Promoting .Interoperability,
.Improvement .Activity, .Cost
October .of .each .year .- .correct .answer.When .are .Star .Ratings .publicly .published?
Surveys, .Medical .Chart .Reviews, .Insurance .Claims, .Medical .Office .Visits, .Procedures .-
.correct .answer.HEDIS .types .of .collection
Medicare .Administrative .Contractor .- .correct .answer.What .does .Abbreviation .MAC .stand
.for?
1.0 .- .correct .answer.Each .year, .Medicare .normalizes .risk .scores .to .maintain .an .average
.of .what?
Inpatient .admission .note .- .correct .answer.Which .type .of .documentation .can .be .used .to
.support .diagnoses .reported .under .risk .adjustment .models?
Determine .projected .costs .of .health .care .based .on .the .condition(s) .of .patients .- .correct
.answer.Risk .adjustment .models .are .used .to:
Yes, .additional .current .diagnoses .not .included .on .claims .data .may .be .approved .during
.the .audit. .- .correct .answer.When .submitting .records .for .RADV .audit, .will .additional
.current .diagnoses .that .were .not .originally .reported .be .considered .when .documentation .is
.submitted .for .the .audit?
Current .year's .known .diagnoses .- .correct .answer.For .commercial .plans, .funding .is
.allocated .based .on
Failure .to .code .for .a .chronic .condition .the .patient .has .may .result .in .an .inaccurate .RAF. .-
.correct .answer.What .is .the .impact .on .reimbursement .under .the .risk .adjustment .model .if
.chronic .conditions .are .not .coded .properly?
, To .evaluate .the .appropriateness .of .risk .scores .to .patients. .- .correct .answer.What .is .the
.purpose .of .a .RADV
5 .- .correct .answer.How .many .records .are .submitted .by .health .plans .per .patient .in .a
.RADV .audit?
I. .Complete .list .and .legible .records .
2. .Credential .for .the .rendering .provider
3.Provider .signature .or .attestation .- .correct .answer.Each .record .submitted .for .a .RADV
.should .include:
Determine .suspected .diagnoses .based .on .data .elements. .- .correct .answer.How .is
.predictive .modeling .used .in .risk .adjustment?
Disease .Management .Programs .- .correct .answer.What .might .happen .as .a .result .of
.predictive .modeling?
Outcomes .- .correct .answer.In .the .CMS .Star .Ratings .program, .which .measure .is .given
.the .highest .weight?
Financial .penalties .will .be .averaged .over .the .plan .membership .- .correct .answer.The
.results .of .a .RADV .audit .are .extrapolated .across .all .members .of .the .plan .that .was
.audited. .What .does .this .mean?
1. .There .is .a .potential .of .loss .of .revenue
2. .Billing .compliance .issues .might .come .too .light .- .correct .answer.Retrospective .audits
.generally .include .finding .additional .diagnoses, .CMS .has .stated .that .the .deletion .of
.conditions .needs .to .be .part .of .these .audits; .why .is .it .so .hard .for .companies .to .follow .CMS
.directives?
provider .signature, .credentials, .and .two .patient .ID's. .The .printed .provider .name .is .only
.necessary .when .the .signature .is .illegible .and .there .is .a .need .to .identify .the .provider. .-
.correct .answer.RADV/IVA .audit .submissions .typically .require:
1.Can .be .performed .by .internal .employees.
2.Can .be .performed .by .external .consultants .who .sign .a .business .agreement
3. .Performed .after .data .was .submitted .- .correct .answer.Which .statements .are .TRUE
.regarding .retrospective .audits?
provider .is .queried .and .an .addendum/late .entry .is .created .to .address .the .conflicting
.information. .- .correct .answer.If .a .medical .record .has .conflicting .information .documented,
.how .is .it .resolved?
E43 .- .correct .answer.Patient .diagnosed .with .severe .protein .calorie .malnutrition. .What .is
.the .appropriate .diagnosis .coding?
With Correct Answers 2024
What .are .extra .RA .values .or .factors .added .when .a .patient .has .more .than .one .major
.significant .dx .identified .in .model .? .- .correct .answer.Interactions
MIPS .Collection .Types .Categories .- .correct .answer.Quality, .Promoting .Interoperability,
.Improvement .Activity, .Cost
October .of .each .year .- .correct .answer.When .are .Star .Ratings .publicly .published?
Surveys, .Medical .Chart .Reviews, .Insurance .Claims, .Medical .Office .Visits, .Procedures .-
.correct .answer.HEDIS .types .of .collection
Medicare .Administrative .Contractor .- .correct .answer.What .does .Abbreviation .MAC .stand
.for?
1.0 .- .correct .answer.Each .year, .Medicare .normalizes .risk .scores .to .maintain .an .average
.of .what?
Inpatient .admission .note .- .correct .answer.Which .type .of .documentation .can .be .used .to
.support .diagnoses .reported .under .risk .adjustment .models?
Determine .projected .costs .of .health .care .based .on .the .condition(s) .of .patients .- .correct
.answer.Risk .adjustment .models .are .used .to:
Yes, .additional .current .diagnoses .not .included .on .claims .data .may .be .approved .during
.the .audit. .- .correct .answer.When .submitting .records .for .RADV .audit, .will .additional
.current .diagnoses .that .were .not .originally .reported .be .considered .when .documentation .is
.submitted .for .the .audit?
Current .year's .known .diagnoses .- .correct .answer.For .commercial .plans, .funding .is
.allocated .based .on
Failure .to .code .for .a .chronic .condition .the .patient .has .may .result .in .an .inaccurate .RAF. .-
.correct .answer.What .is .the .impact .on .reimbursement .under .the .risk .adjustment .model .if
.chronic .conditions .are .not .coded .properly?
, To .evaluate .the .appropriateness .of .risk .scores .to .patients. .- .correct .answer.What .is .the
.purpose .of .a .RADV
5 .- .correct .answer.How .many .records .are .submitted .by .health .plans .per .patient .in .a
.RADV .audit?
I. .Complete .list .and .legible .records .
2. .Credential .for .the .rendering .provider
3.Provider .signature .or .attestation .- .correct .answer.Each .record .submitted .for .a .RADV
.should .include:
Determine .suspected .diagnoses .based .on .data .elements. .- .correct .answer.How .is
.predictive .modeling .used .in .risk .adjustment?
Disease .Management .Programs .- .correct .answer.What .might .happen .as .a .result .of
.predictive .modeling?
Outcomes .- .correct .answer.In .the .CMS .Star .Ratings .program, .which .measure .is .given
.the .highest .weight?
Financial .penalties .will .be .averaged .over .the .plan .membership .- .correct .answer.The
.results .of .a .RADV .audit .are .extrapolated .across .all .members .of .the .plan .that .was
.audited. .What .does .this .mean?
1. .There .is .a .potential .of .loss .of .revenue
2. .Billing .compliance .issues .might .come .too .light .- .correct .answer.Retrospective .audits
.generally .include .finding .additional .diagnoses, .CMS .has .stated .that .the .deletion .of
.conditions .needs .to .be .part .of .these .audits; .why .is .it .so .hard .for .companies .to .follow .CMS
.directives?
provider .signature, .credentials, .and .two .patient .ID's. .The .printed .provider .name .is .only
.necessary .when .the .signature .is .illegible .and .there .is .a .need .to .identify .the .provider. .-
.correct .answer.RADV/IVA .audit .submissions .typically .require:
1.Can .be .performed .by .internal .employees.
2.Can .be .performed .by .external .consultants .who .sign .a .business .agreement
3. .Performed .after .data .was .submitted .- .correct .answer.Which .statements .are .TRUE
.regarding .retrospective .audits?
provider .is .queried .and .an .addendum/late .entry .is .created .to .address .the .conflicting
.information. .- .correct .answer.If .a .medical .record .has .conflicting .information .documented,
.how .is .it .resolved?
E43 .- .correct .answer.Patient .diagnosed .with .severe .protein .calorie .malnutrition. .What .is
.the .appropriate .diagnosis .coding?
