Exam Risk Adjustment CRC exam-with 100% verified solutions 2026-2027-tutor verified (Complete And Verified Study material) (4pages) LEARNEXAMS

1. Which type of documentation can be used to support diagnoses reported under risk adjustment models? Inpatient admission note 2. Risk adjustment models are used to: Determine projected costs of health care based on the condition(s) of patients 3. When submitting records for RADV audit, will additional current diagnoses that were not originally reported be considered when documentation is submitted for the audit? Yes, additional current diagnoses not included on claims data may be approved during the audit. 4. For commercial plans, funding is allocated based on? Current year's known diagnoses 5. What is the impact on reimbursement under the risk adjustment model if chronic conditions are not coded properly? Failure to code for a chronic condition the patient has may result in an inaccurate RAF. 6. What is the purpose of a RADV? To evaluate the appropriateness of risk scores to patients. 7. How many records are submitted by health plans per patient in a RADV audit? 5 8. Each record submitted for a RADV should include: I. Complete list and legible records 2. Credential for the rendering provider 3.Provider signature or attestation 9. How is predictive modeling used in risk adjustment? Determine suspected diagnoses based on data elements. 10. What might happen as a result of predictive modeling? Disease Management Programs 11. In the CMS Star Ratings program, which measure is given the highest weight? Outcomes 12. The results of a RADV audit are extrapolated across all members of the plan that was audited. What does this mean? Financial penalties will be averaged over the plan membership 13. 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? 1. There is a potential of loss of revenue 2. Billing compliance issues might come too light 14. RADV/IVA audit submissions typically require: provider signature