EMILLECT 2024/2025 ACADEMIC YEAR ©2024 EMILLECT. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER 2024.
CRC EXAM STUDY GUIDE WITH
COMPLETE SOLUTIONS
Risk Adjustment Data Element - Answer✔✔-Age, Gende, Socioeconomic status, Disability status,
Insurance status(Medicaid, dual-eligible,) Claims data elements such as procedure codes, place of service
codes, special patient-specific conditions hospice, ESRD
RAF - Answer✔✔-Risk Adjustment Factor Scores
Three main types of reviews - Answer✔✔-Retrospective, Concurrent and prospective
Retrospective - Answer✔✔-reviews are performed after the information has been reported and in risk
adjustment these are prior years dos
Concurrent reviews - Answer✔✔-performed ongoing as patients are seen prior to reporting and in risk
adjustment the current year
Prospective reviews - Answer✔✔-will effect the next year and not the current year where payment is
concerned. They are used to forcast
Types of Risk Adjustment Models(HHS) - Answer✔✔-HHS hEALTH AND HUMAN SERVICES hIERARCHICAL
CONDITION(Commercial, individual and small grooup
Types of Risk Adjustment Modles(CDPS) - Answer✔✔-Chronic Illness and Disability payment
systems(Medicaid)
Types of Risk Adjustment Models(HCC-C) - Answer✔✔-Hierarchical Condition Category, Part C
Page 1/7
, EMILLECT 2024/2025 ACADEMIC YEAR ©2024 EMILLECT. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER 2024.
Types of Risk Adjustment model (DRG) - Answer✔✔-Diagnosis Related Group (Inpatient)
Types of Risk Adjustment model (ACG) - Answer✔✔-Adjusted Clinical Groups(Outpatient)
Prescription based program risk adjustment examples:UCSD - Answer✔✔-Medicaid Rx(UCSD)
Prescription based program risk adjustment examples(Dxcg) - Answer✔✔-RxGroups(DxCG)
Prescription based program risk adjustment examples(HCC-D) - Answer✔✔-Hierarchical Condition
Category, Part D(HCC-D
Trump List - Answer✔✔-Families or hierarchies set a value base on severity of illness with more severe
diagnoses carrying the overall risk score for that family.
Stage 1 Pressure Ulcer - Answer✔✔-Persistent focal erythema
stage 2 pressure ulcer - Answer✔✔-Partial thickness skin loss involving epidermis, dermis, or both
Stage 3 pressure ulcer - Answer✔✔-Full Thickness skin loss extending through subcutaneous tissue
Stage 4 Pressure ulcer - Answer✔✔-Necrosis of soft tissue extending to muscle and bone
Unstageable Ulce - Answer✔✔-is covered in eschar or slough it cannot be determine how deep
Pathologic Fractures - Answer✔✔-Broken bone that occures in an area of weakened bone. The cause
typically due to another disease such as neoplasm or osteoporosis
Stress Fractures - Answer✔✔-repeated force or overuse. these fractures are considered non-traumatic
malunion fracture - Answer✔✔-a healed fracture in a undesirable position resulting in a deformity or
crooked limb.
Page 2/7
CRC EXAM STUDY GUIDE WITH
COMPLETE SOLUTIONS
Risk Adjustment Data Element - Answer✔✔-Age, Gende, Socioeconomic status, Disability status,
Insurance status(Medicaid, dual-eligible,) Claims data elements such as procedure codes, place of service
codes, special patient-specific conditions hospice, ESRD
RAF - Answer✔✔-Risk Adjustment Factor Scores
Three main types of reviews - Answer✔✔-Retrospective, Concurrent and prospective
Retrospective - Answer✔✔-reviews are performed after the information has been reported and in risk
adjustment these are prior years dos
Concurrent reviews - Answer✔✔-performed ongoing as patients are seen prior to reporting and in risk
adjustment the current year
Prospective reviews - Answer✔✔-will effect the next year and not the current year where payment is
concerned. They are used to forcast
Types of Risk Adjustment Models(HHS) - Answer✔✔-HHS hEALTH AND HUMAN SERVICES hIERARCHICAL
CONDITION(Commercial, individual and small grooup
Types of Risk Adjustment Modles(CDPS) - Answer✔✔-Chronic Illness and Disability payment
systems(Medicaid)
Types of Risk Adjustment Models(HCC-C) - Answer✔✔-Hierarchical Condition Category, Part C
Page 1/7
, EMILLECT 2024/2025 ACADEMIC YEAR ©2024 EMILLECT. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER 2024.
Types of Risk Adjustment model (DRG) - Answer✔✔-Diagnosis Related Group (Inpatient)
Types of Risk Adjustment model (ACG) - Answer✔✔-Adjusted Clinical Groups(Outpatient)
Prescription based program risk adjustment examples:UCSD - Answer✔✔-Medicaid Rx(UCSD)
Prescription based program risk adjustment examples(Dxcg) - Answer✔✔-RxGroups(DxCG)
Prescription based program risk adjustment examples(HCC-D) - Answer✔✔-Hierarchical Condition
Category, Part D(HCC-D
Trump List - Answer✔✔-Families or hierarchies set a value base on severity of illness with more severe
diagnoses carrying the overall risk score for that family.
Stage 1 Pressure Ulcer - Answer✔✔-Persistent focal erythema
stage 2 pressure ulcer - Answer✔✔-Partial thickness skin loss involving epidermis, dermis, or both
Stage 3 pressure ulcer - Answer✔✔-Full Thickness skin loss extending through subcutaneous tissue
Stage 4 Pressure ulcer - Answer✔✔-Necrosis of soft tissue extending to muscle and bone
Unstageable Ulce - Answer✔✔-is covered in eschar or slough it cannot be determine how deep
Pathologic Fractures - Answer✔✔-Broken bone that occures in an area of weakened bone. The cause
typically due to another disease such as neoplasm or osteoporosis
Stress Fractures - Answer✔✔-repeated force or overuse. these fractures are considered non-traumatic
malunion fracture - Answer✔✔-a healed fracture in a undesirable position resulting in a deformity or
crooked limb.
Page 2/7
