Certified Risk Adjustment Coder (CRC) practice
exam Questions And Answers|100
%C0rrect|Grade A+
CRC Practice Exam – Questions 1–50
1. Which of the following is the primary purpose of risk
adjustment?
A. Improve physician reimbursement only
B. Predict future healthcare costs
C. Reduce hospital readmissions
D. Eliminate coding errors
Answer: B
Risk adjustment models estimate expected costs based on disease
burden.
2. What does HCC stand for in risk adjustment coding?
A. Hierarchical Category of Care
B. Health Care Classification
C. Hierarchical Condition Category
D. Hospital Coding Category
Answer: C
HCCs group clinically related diagnoses that predict cost.
3. Which risk model is used by CMS for Medicare Advantage?
A. HHS-HCC
B. CMS-HCC
C. CDPS
D. Medicaid Rx
,Answer: B
CMS-HCC is the model for Medicare Advantage plans.
4. Which of the following documentation elements is required for
diagnosis coding?
A. Date and signature only
B. MEAT
C. PMH only
D. Medication list
Answer: B
CMS requires diagnoses to be supported by MEAT: Monitor, Evaluate,
Assess, Treat.
5. Diabetes with chronic kidney disease maps to which concept?
A. A single additive HCC
B. Diabetes HCC only
C. CKD HCC only
D. No HCC
Answer: A
Combination codes for diabetic CKD risk-adjust and are additive.
6. Which diagnosis cannot be coded in an outpatient setting?
A. Suspected stroke
B. Chronic heart failure
C. Diabetes type 2
D. COPD
Answer: A
Outpatient coding forbids coding "rule out," "suspected," “probable.”
, 7. Which provider type is acceptable for risk-adjustment diagnosis
capture?
A. Chiropractor
B. Dentist
C. Nurse practitioner
D. Acupuncturist
Answer: C
Only licensed treating providers eligible to bill Medicare may capture
diagnoses.
8. What does RAF stand for?
A. Risk Adjustment Factor
B. Relative Assignment File
C. Rate Adjustment Formula
D. Risk Accounting Factor
Answer: A
RAF scores quantify disease burden per patient.
9. Which documentation term supports coding obesity?
A. “Overweight”
B. “BMI elevated”
C. “Clinically obese”
D. “Large build”
Answer: C
Provider must diagnose obesity—not inferred from BMI.
10. A patient with COPD and acute lower respiratory infection
should be coded as:
exam Questions And Answers|100
%C0rrect|Grade A+
CRC Practice Exam – Questions 1–50
1. Which of the following is the primary purpose of risk
adjustment?
A. Improve physician reimbursement only
B. Predict future healthcare costs
C. Reduce hospital readmissions
D. Eliminate coding errors
Answer: B
Risk adjustment models estimate expected costs based on disease
burden.
2. What does HCC stand for in risk adjustment coding?
A. Hierarchical Category of Care
B. Health Care Classification
C. Hierarchical Condition Category
D. Hospital Coding Category
Answer: C
HCCs group clinically related diagnoses that predict cost.
3. Which risk model is used by CMS for Medicare Advantage?
A. HHS-HCC
B. CMS-HCC
C. CDPS
D. Medicaid Rx
,Answer: B
CMS-HCC is the model for Medicare Advantage plans.
4. Which of the following documentation elements is required for
diagnosis coding?
A. Date and signature only
B. MEAT
C. PMH only
D. Medication list
Answer: B
CMS requires diagnoses to be supported by MEAT: Monitor, Evaluate,
Assess, Treat.
5. Diabetes with chronic kidney disease maps to which concept?
A. A single additive HCC
B. Diabetes HCC only
C. CKD HCC only
D. No HCC
Answer: A
Combination codes for diabetic CKD risk-adjust and are additive.
6. Which diagnosis cannot be coded in an outpatient setting?
A. Suspected stroke
B. Chronic heart failure
C. Diabetes type 2
D. COPD
Answer: A
Outpatient coding forbids coding "rule out," "suspected," “probable.”
, 7. Which provider type is acceptable for risk-adjustment diagnosis
capture?
A. Chiropractor
B. Dentist
C. Nurse practitioner
D. Acupuncturist
Answer: C
Only licensed treating providers eligible to bill Medicare may capture
diagnoses.
8. What does RAF stand for?
A. Risk Adjustment Factor
B. Relative Assignment File
C. Rate Adjustment Formula
D. Risk Accounting Factor
Answer: A
RAF scores quantify disease burden per patient.
9. Which documentation term supports coding obesity?
A. “Overweight”
B. “BMI elevated”
C. “Clinically obese”
D. “Large build”
Answer: C
Provider must diagnose obesity—not inferred from BMI.
10. A patient with COPD and acute lower respiratory infection
should be coded as:
