CRC Exam Questions Answers

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CRC Exam Questions & Answers 1.How is predictive modeling used in risk adjustment ANS to determine suspected diagnosis based on data elements.

2.Which of the following data elements are used in predictive modeling?I.DME claims II.Prescription drug events III.Physician claims data IV.Facility claims data a.III and IV b.I, II, and IV c.I, II, and III d.I, II, III, and IV

ANS: d. I, II, III, and IV

3.What might happen as a result of predictive modeling?a.Disease management programs b.Concurrent audits c.Transporation benefits d.Reduction in case management

ANS: a. Disease management programs

4.In the CMS Star Ratings program, which measure is given the 1 / 4

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highest weight?a.Outcomes b.Patient experience c.Customer service d.Accurate RAF scores

ANS: a. Outcomes

5.How often are HEDIS measures revised?a.As needed b.Monthly c.Bi-annually d.Annually

ANS: d. Annually

6.Which statement is TRUE regarding the CMS Stars quality rating system?a.Quality bonus payments are made to physician who score at least four stars.b.Quality bonus payments are made to Medicare Advantage plans who score at least four stars.c.Quality bonus payments are made to physician who score at least five stars.d.Quality bonus payments are made to Medicare Advantage plans who score at least five stars.

ANS: b. Quality bonus payments are made to Medicare Advantage plans

who score at least four stars. 2 / 4

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7.Merit-based Incentive Payment System (MIPS) includes which performance categories?I.Promoting Interoperability II.Cost III.Improvement Activities IV.Quantity V.Quality a.I and II b.I, III, and V c.I, II, III, and V d.I, II, III, IV, and V

ANS: c. I, II, III, and V

8.Which of the following are domains in CMS Part C & D Stars Rating?I.Staying Healthy II.Managing Chronic Conditions III.Member Experience with Health Plans IV.Member Complaints, Problems Getting Services, and Improvement in the Health Plan's Performance V.Health Plan Customer Service a.I, II and III b.I, III, and V c.I, II, III, IV and V d.I, II, III and V 3 / 4

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ANS: c. I, II, III, IV and V

9.What are the participation tracks available through Medicare Access and CHIP Reauthorization Act (MACRA)?I.Merit-based Incentive Payment Systems II.Sustainable Growth System III.Advanced Alternative Payment Models a. I b.II and III c.I and III d.I, II and III

ANS: c. I and III

10.What is predictive modeling?a.An analytical review of known data elements to establish a hypothesis related to the future health of patients.b.An analytical review of payments to health plans to determine the cost of future healthcare.c.An average of costs associated with diagnoses used to determine which providers to contract with for a health plan.d.An average payment associated with diagnoses used to determine which health plans providers should contract with.

ANS: a. An analytical review of known data elements to establish a

hypothesis related to the future health of patients.

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