AAPC CRC Exam 9 With Over 1500 Correctly
Answered Questions 2023 Update.
purpose of risk adjustment - Exact Answer allows CMS to pay plans for the risk
of the beneficiaries they enroll, instead of an average amount for Medicare
beneficiaries
adjusting payment plans - Exact Answer CMS able to make appropriate and
accurate payments for enrollees with differences in expected costs
risk scores - Exact Answer measure individual beneficiaries' relative risk and are
used to adjust payments for each beneficiary's expected expenditures
risk scores - Exact Answer allows CMS to use standardized bids as base
payments to plans
acceptable data sources - Exact Answer hospital inpatients, hospital outpatient
facilities, and physicians
capturing codes - Exact Answer unique diagnoses at least once during risk
adjustment data-reporting period
final risk score calculation - Exact Answer providers may request recalculation of
payment once error of inaccurate diagnosis submitted for calculating risk scores
have been discovered and have an effect on final payment
,AAPC CRC Exam 9 With Over 1500 Correctly
Answered Questions 2023 Update.
risk adjustment models - Exact Answer use to calculate risk scores which
predicts healthcare expenditures.
PACE - Exact Answer program of all-inclusive care for the elderly:
PACE - Exact Answer frail and elderly individuals eligible for nursing home
placement based on state medicaid criteria
CMS center for beneficiary choices - Exact Answer develops and implements ra
payment methodology for MM program. monitors plans to improve data quality
CMS regional office - Exact Answer provide assistance to ra organization and
beneficiaris
palmetto government benefits admin (palmetto gba) - Exact Answer manages
front-end ra system (FERAS) and customer service and support center (CSSC)
RAPS - Exact Answer risk adjustment processing system
multiple chronic diseases - Exact Answer risk adjusted payment based on
assignment of dx to disease groups, HCC. most influenced by medicare costs
associated with chronic diseases
,AAPC CRC Exam 9 With Over 1500 Correctly
Answered Questions 2023 Update.
interactions - Exact Answer allow for additive factors based on chronic
conditions and disabled status to increase payment accuracy
hierarchies - Exact Answer allow for payment based on most serious conditions
when less serious conditions exist
new enrollee - Exact Answer CMS uses medicare FFS up to 12 months of data
collected within collection period to calculate risk score. If data is submitted via
RAPS, CMS uses those too.
risk score (5 demographic factors) - Exact Answer calculate risk score: age, sex,
medicaid status, disability and original reason for medicare entitlement
disease interactions - Exact Answer 6 in community model; 5 in institutional
model
disable interactions - Exact Answer 5 in community; 4 institutional
FERAS - Exact Answer front-end risk adjustment system; ra submitters sends
data to palmetto through FERAS
RAPS - Exact Answer risk adjustment processing system; process ra data
, AAPC CRC Exam 9 With Over 1500 Correctly
Answered Questions 2023 Update.
RAS - Exact Answer risk adjustment system; calculates risk score
common UI - Exact Answer maintains medicare beneficiary eligibility data
HPMS - Exact Answer health plan management system; CMS MA information
system that contains health plan-level data
required diagnosis - Exact Answer diagnosis codes required to be submitted for
the CMS-HCC model and future model development
ra data - Exact Answer ra data must be submitted at least quarterly; processed
through RAPS
ra data requirements - Exact Answer health insurance claim (HIC) #, diagnosis
code, service date from, service date through, provider type
ra data requirements diagnosis - Exact Answer diagnosis codes must be
reported at least once per enrollee within data collection period
ra data flow - Exact Answer **hospital/physician submits data to MA
organization
**MA organization submits data at least quarterly to Palmetto GBA
**MA organization submits data via Direct Data Entry or in RAPS format
Answered Questions 2023 Update.
purpose of risk adjustment - Exact Answer allows CMS to pay plans for the risk
of the beneficiaries they enroll, instead of an average amount for Medicare
beneficiaries
adjusting payment plans - Exact Answer CMS able to make appropriate and
accurate payments for enrollees with differences in expected costs
risk scores - Exact Answer measure individual beneficiaries' relative risk and are
used to adjust payments for each beneficiary's expected expenditures
risk scores - Exact Answer allows CMS to use standardized bids as base
payments to plans
acceptable data sources - Exact Answer hospital inpatients, hospital outpatient
facilities, and physicians
capturing codes - Exact Answer unique diagnoses at least once during risk
adjustment data-reporting period
final risk score calculation - Exact Answer providers may request recalculation of
payment once error of inaccurate diagnosis submitted for calculating risk scores
have been discovered and have an effect on final payment
,AAPC CRC Exam 9 With Over 1500 Correctly
Answered Questions 2023 Update.
risk adjustment models - Exact Answer use to calculate risk scores which
predicts healthcare expenditures.
PACE - Exact Answer program of all-inclusive care for the elderly:
PACE - Exact Answer frail and elderly individuals eligible for nursing home
placement based on state medicaid criteria
CMS center for beneficiary choices - Exact Answer develops and implements ra
payment methodology for MM program. monitors plans to improve data quality
CMS regional office - Exact Answer provide assistance to ra organization and
beneficiaris
palmetto government benefits admin (palmetto gba) - Exact Answer manages
front-end ra system (FERAS) and customer service and support center (CSSC)
RAPS - Exact Answer risk adjustment processing system
multiple chronic diseases - Exact Answer risk adjusted payment based on
assignment of dx to disease groups, HCC. most influenced by medicare costs
associated with chronic diseases
,AAPC CRC Exam 9 With Over 1500 Correctly
Answered Questions 2023 Update.
interactions - Exact Answer allow for additive factors based on chronic
conditions and disabled status to increase payment accuracy
hierarchies - Exact Answer allow for payment based on most serious conditions
when less serious conditions exist
new enrollee - Exact Answer CMS uses medicare FFS up to 12 months of data
collected within collection period to calculate risk score. If data is submitted via
RAPS, CMS uses those too.
risk score (5 demographic factors) - Exact Answer calculate risk score: age, sex,
medicaid status, disability and original reason for medicare entitlement
disease interactions - Exact Answer 6 in community model; 5 in institutional
model
disable interactions - Exact Answer 5 in community; 4 institutional
FERAS - Exact Answer front-end risk adjustment system; ra submitters sends
data to palmetto through FERAS
RAPS - Exact Answer risk adjustment processing system; process ra data
, AAPC CRC Exam 9 With Over 1500 Correctly
Answered Questions 2023 Update.
RAS - Exact Answer risk adjustment system; calculates risk score
common UI - Exact Answer maintains medicare beneficiary eligibility data
HPMS - Exact Answer health plan management system; CMS MA information
system that contains health plan-level data
required diagnosis - Exact Answer diagnosis codes required to be submitted for
the CMS-HCC model and future model development
ra data - Exact Answer ra data must be submitted at least quarterly; processed
through RAPS
ra data requirements - Exact Answer health insurance claim (HIC) #, diagnosis
code, service date from, service date through, provider type
ra data requirements diagnosis - Exact Answer diagnosis codes must be
reported at least once per enrollee within data collection period
ra data flow - Exact Answer **hospital/physician submits data to MA
organization
**MA organization submits data at least quarterly to Palmetto GBA
**MA organization submits data via Direct Data Entry or in RAPS format
