CRC Exam With Guaranteed Accurate Answers

Risk Adjustment (a prospective payment system) - correct answer 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. What is the goal when coding for risk adjustment? - correct answer code ALL current dx What is the purpose of collecting dx in risk adjustment coding? - correct answer Adjust potential risk measure & eval all Pts on an equal scale levels the playing field of age, race, gender, & socioeconomics What is the acronym for risk adjustment coding? - correct answer HCC (Hierarchical Condition Category) What elements would NOT be taken in to consideration for risk adjustment? - correct answer number of years Pt. has been covered under medicare advantage Which medical records can be submitted for HCC validation? - correct answer +MD office progress note +Outpatient hospital +Critical access hospital What is the purpose of risk adjustment values? - correct answer to budget care of a patient for the following year What are risk adjustment models used for? - correct answer To determine projected costs of healthcare based on the conditions of patients Which is NOT to be taken into consideration for risk adjustment? - correct answer Frequency of office visits How is predictive modeling used in risk adjustment? - correct answer determine suspected dx based on data elements What is the reporting period for risk adjustment coding? - correct answer Jan Dec What risk adjustment model is used by Medicaid? - correct answer CDPS (Chronic Illness & Disability Payment System) What is CDPS? - correct answer Chronic Illness & Disability Payment System What risk adjustment model incorporates High, Medium, & Low risk in the numeric value - correct answer CDPS what is the default if type of DM is not specified? - correct answer DM2 How to code when a Pt. is seen for management of anemia d/t malignancy? - correct answer 1st code - malignancy 2nd code - anemia How to code tobacco use AND dependence on tobacco - correct answer only code dependence on tobacco (F17.2-) What is the length of time for a MI to be considered "acute"? - correct answer 4 weeks/28 days How is glaucoma reported? - correct answer only code stage of glaucoma What is the sequencing order when coding a sequela (late effect)? - correct answer 1st- residual condition 2nd- cause of the late effect What is reported by a provider for beneficiaries in Medicare Advantage plans? - correct answer presenting problems, & all chronic conditions How often should a provider see a Pt. to validate amputation status? - correct answer once a year PEG Tube - correct answer +percutaneous endoscopic gastrostomy tube +G-tube +gastrostomy All conditions listed on the problem list for DM patients are coded as complications of DM: True or False? - correct answer False What is true regarding hierarchies? - correct answer Utilized by some private payers Quality Measures like Star Ratings and HEDIS have NO correlation with the medical record that is collected to support risk adjustment. TRUE or FALSE? - correct answer FALSE Is HEDIS a division of CMS or Medicaid? - correct answer NO Who developed HEDIS? - correct answer NCQA (National Committee for Quality Assurance) How is HEDIS data collected? - correct answer +surveys +medical chart reviews +insurance claims What is the goal of HEDIS (Health Plan Employer Data Info Set)? - correct answer for consumers to compare health plans How often are HEDIS measures revised? - correct answer Annually Which payers uses HEDIS measures? - correct answer a variety RADV - correct answer Risk Adjustment Data Validation What is the purpose of a RADV