- | P a g e
CRC EXAM NEWEST 2024-2025 ACTUAL EXAM
COMPLETE 200 QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+
Which type of documentation can be used to support diagnoses reported under risk adjustment models?
- Inpatient admission note
- CT scan results
- CBC lab test
- Comprehensive problem list - ANSWER- a. Inpatient admission note
Which statement is TRUE regarding diagnosis codes and assigned HCCs?
- all diagnosis are assigned an HCC.
- all chronic illness are assigned an HCC.
- not all diagnosis codes are assigned an HCC.
- all acute exacerbations of an acute illness are assigned an HCC. -
ANSWER- c. not all diagnosis codes are assigned an HCC
Where can a list of diagnosis mappings to HCCs be located?
- OIG website.
- CMS website.
- OCR website. 1 / 4
- | P a g e
- QPP website. - ANSWER- b. CMS website.
Which of the following is TRUE regarding the risk adjustment model by HHS?
- States are mandated to use the Medicare HCCs.
- States can either use the federal methodology or propose an alternate
- States can either use the federal methodology or exclude risk
- States can determine their own policy for payment without a risk
for certification by HHS.
adjustment logic from reimbursement.
adjustment component. - ANSWER- b. States can either use the federal methodology or propose an alternate for certification by HHS.
When reporting a code for retinopathy, must the coder find documentation from an ophthalmologist in order to code the condition as an active condition?
- yes, speciality specific diagnosis can only be reported by a specialist.
- yes, ophthalmologist must diagnosis all eye related conditions.
- No, any approved provider can validate any diagnosis.
- No only PCP can provide supporting documentation for reported
diagnoses. - ANSWER- c. No, any approved provider can validate any diagnosis.
Under the Affordable Care Act(ACA), can health plans change the premium rate based on a patient's health status where patients with more complex medical issues are required to pay a higher premium than patients with less complex medical issues? 2 / 4
- | P a g e
- Yes, as long as the more complex medical conditions are documented.
- Yes, as long as the patient discloses the information when enrolling in
- No, health plans can not charge different premiums based on health
- No, health plans are prohibited from participating in the ACA risk
a plan on the health care exchange.
status.
adjustment model. - ANSWER- c. No, health plans can not charge different premiums based on health status.
How often is the normalization factor adjusted?
- monthly
- twice per year
- yearly
- as needed - ANSWER- c. yearly
RA must be compared to average FFS expenses and rates. The purpose of the FFS normalization adjustment issue that CMS payments are based on a population with an average risk score of 1.0. This s the national average. Annually, Medicare normalizes the risk scores to maintain an average res score of 1.0.
Risk adjustment models are used to:
- Limit coverage of chronic conditions.
- Determine projected costs of healthcare based on conditions of
- Determine the return on investment for developing proactive disease
patients.
prevention outreach. 3 / 4
- | P a g e
- Limit the coverage of hospital admissions. - ANSWER- b. Determine
projected costs of healthcare based on conditions of patients.
What are the extra risk adjustment values or factors added when a patient has more than one major significant diagnosis identified in the model?
- interactions
- risk factors.
- demographic variances
- exceptions - ANSWER- a. interactions
Interactions are extra risk adjustment values or factors added when a patient has more than one major significant diagnosis identified in the model. These interactions add value because it is understood that having a combination of some diagnoses together increase clinical risk and associated costs of care.
Each year, Medicare normalizes risk scores to maintain an average of what? - ANSWER- 1.0
What does the abbreviation CDPS indicate?
- Chronic Disability Provider Services
- Chronic Diagnosis Processing System
- Chronic Disability Payment System
- Chronic Disability Payment System - ANSWER- c. Chronic
- / 4
Disability Payment System CDPS is the RA model used by Medicaid