CRC Exam Questions Answers

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CRC Exam Questions & Answers 1.Risk Adjustment (a prospective payment system) ANS The process of increasing or reducing payments to health plans to reflect higher or lower than expected spending. Risk adjusting is designed to compensate health plans that enroll an older and sicker population as a way to discourage plans from selecting only healthier enrollees.

2.What is the goal when coding for risk adjustment?ANS code ALL current dx 3.What is the purpose of collecting dx in risk adjustment coding?ANS Adjust potential risk measure & eval all Pts on an equal scale levels the playing field of age, race, gender, & socioeconomics 4.What is the acronym for risk adjustment coding?ANS HCC (Hierarchical Condi- tion Category) 5.What elements would NOT be taken in to consideration for risk adjustment?- ANS number of years Pt. has been covered under medicare advantage 1 / 4

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6.Which medical records can be submitted for HCC validation?ANS +MD office progress note +Outpatient hospital +Critical access hospital 7.What is the purpose of risk adjustment values?ANS to budget care of a patient for the following year 8.What are risk adjustment models used for?ANS To determine projected costs of healthcare based on the conditions of patients 9.Which is NOT to be taken into consideration for risk adjustment?ANS Frequency of office visits 10.How is predictive modeling used in risk adjustment?ANS determine suspected dx based on data elements 11.What is the reporting period for risk adjustment coding?ANS Jan > Dec 12.What risk adjustment model is used by Medicaid?ANS CDPS (Chronic Illness & Disability Payment System) 13.What is CDPS? 2 / 4

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ANS Chronic Illness & Disability Payment System 14.What risk adjustment model incorporates High, Medium, & Low risk in the numeric value

ANS CDPS

15.what is the default if type of DM is not specified?

ANS DM2

16.How to code when a Pt. is seen for management of anemia d/t malignan- cy?ANS 1st code - malignancy 2nd code – anemia 17.How to code tobacco use AND dependence on tobacco ANS only code depen- dence on tobacco (F17.2-) 18.What is the length of time for a MI to be considered "acute"?ANS 4 weeks/28 days 19.How is glaucoma reported?ANS only code stage of glaucoma 20.What is the sequencing order when coding a sequela (late effect)? 3 / 4

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ANS 1st- residual condition 2nd- cause of the late effect 21.What is reported by a provider for beneficiaries in Medicare Advantage plans?ANS presenting problems, & all chronic conditions 22.How often should a provider see a Pt. to validate amputation status?ANS once a year 23.PEG Tube ANS +percutaneous endoscopic gastrostomy tube +G-tube +gastrostomy 24.All conditions listed on the problem list for DM patients are coded as complications of DM True or False?ANS False 25.What is true regarding hierarchies?ANS Utilized by some private payers 26.Quality Measures like Star Ratings and HEDIS have NO correlation with the medical record that is collected to support risk adjustment. TRUE

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