Risk Adjustment CRC exam questions
2023 latest
Interactions - CORRECT ANSWER-What are extra RA values or factors added when a
patient has more than
... [Show More] one major significant dx identified in model ?
Quality, Promoting Interoperability, Improvement Activity, Cost - CORRECT ANSWERMIPS Collection Types Categories
When are Star Ratings publicly published? - CORRECT ANSWER-October of each
year
HEDIS types of collection - CORRECT ANSWER-Surveys, Medical Chart Reviews,
Insurance Claims, Medical Office Visits, Procedures
What does Abbreviation MAC stand for? - CORRECT ANSWER-Medicare
Administrative Contractor
Each year, Medicare normalizes risk scores to maintain an average of what? -
CORRECT ANSWER-1.0
Which type of documentation can be used to support diagnoses reported under risk
adjustment models? - CORRECT ANSWER-Inpatient admission note
Risk adjustment models are used to: - CORRECT ANSWER-Determine projected costs
of health care based on the condition(s) of patients
When submitting records for RADV audit, will additional current diagnoses that were not
originally reported be considered when documentation is submitted for the audit? -
CORRECT ANSWER-Yes, additional current diagnoses not included on claims data
may be approved during the audit.
For commercial plans, funding is allocated based on - CORRECT ANSWER-Current
year's known diagnoses
What is the impact on reimbursement under the risk adjustment model if chronic
conditions are not coded properly? - CORRECT ANSWER-Failure to code for a chronic
condition the patient has may result in an inaccurate RAF.
What is the purpose of a RADV - CORRECT ANSWER-To evaluate the
appropriateness of risk scores to patients.
How many records are submitted by health plans per patient in a RADV audit? -
CORRECT ANSWER-5
Each record submitted for a RADV should include: - CORRECT ANSWER-I. Complete
list and legible records
2. Credential for the rendering provider
3.Provider signature or attestation
How is predictive modeling used in risk adjustment? - CORRECT ANSWER-Determine
suspected diagnoses based on data elements.
What might happen as a result of predictive modeling? - CORRECT ANSWER-Disease
Management Programs
In the CMS Star Ratings program, which measure is given the highest weight? -
CORRECT ANSWER-Outcomes
The results of a RADV audit are extrapolated across all members of the plan that was
audited. What does this mean? - CORRECT ANSWER-Financial penalties will be
averaged over the plan membership
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? - CORRECT ANSWER-1. There is a potential of
loss of revenue
2. Billing compliance issues might come too light
RADV/IVA audit submissions typically require: - CORRECT ANSWER-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.
Which statements are TRUE regarding retrospective audits? - CORRECT ANSWER1.Can be performed by internal employees.
2.Can be performed by external consultants who sign a business agreement
3. Performed after data was submitted
If a medical record has conflicting information documented, how is it resolved? -
CORRECT ANSWER-provider is queried and an addendum/late entry is created to
address the conflicting information.
Patient diagnosed with severe protein calorie malnutrition. What is the appropriate
diagnosis coding? - CORRECT ANSWER-E43
Which ICD-10-CM code(s) is/are reported when the provider diagnoses the patient with
adult attention deficit disorder (ADD)? - CORRECT ANSWER-F98.8
Patient is being seen in the Outpatient clinic today for liver cancer of a transplanted
liver. Select the correct code(s). - CORRECT ANSWER-T86.49, C80.2, C22.8 [Show Less]