Risk Adjustment CRC exam questions With Verified Answers

Risk Adjustment CRC exam questions With Verified Answers Interactions - answerWhat are extra RA values or factors added when a patient has more than one major significant dx identified in model ? Quality, Promoting Interoperability, Improvement Activity, Cost - answerMIPS Collection Types Categories When are Star Ratings publicly published? - answerOctober of each year HEDIS types of collection - answerSurveys, Medical Chart Reviews, Insurance Claims, Medical Office Visits, Procedures What does Abbreviation MAC stand for? - answerMedicare Administrative Contractor Each year, Medicare normalizes risk scores to maintain an average of what? - answer1.0 Which type of documentation can be used to support diagnoses reported under risk adjustment models? - answerInpatient admission note Risk adjustment models are used to: - answerDetermine projected costs of health care based on the condition(s) of patients When submitting records for RADV audit, will additional current diagnoses that were not originally reported be considered when documentation is submitted for the audit? - answerYes, additional current diagnoses not included on claims data may be approved during the audit. For commercial plans, funding is allocated based on - answerCurrent year's known diagnoses What is the impact on reimbursement under the risk adjustment model if chronic conditions are not coded properly? - answerFailure to code for a chronic condition the patient has may result in an inaccurate RAF. What is the purpose of a RADV - answerTo evaluate the appropriateness of risk scores to patients. How many records are submitted by health plans per patient in a RADV audit? - answer5 Each record submitted for a RADV should include: - answerI. Complete list and legible records 2. Credential for the rendering provider 3.Provider signature or attestation How is predictive modeling used in risk adjustment? - answerDetermine suspected diagnoses based on data elements. What might happen as a result of predictive modeling? - answerDisease Management Programs In the CMS Star Ratings program, which measure is given the highest weight? - answerOutcomes The results of a RADV audit are extrapolated across all members of the plan that was audited. What does this mean? - answerFinancial penalties will be averaged over the plan membership 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? - answer1. There is a potential of loss of revenue 2. Billing compliance issues might come too light RADV/IVA audit submissions typically require: - answerprovider signature, credentials, and two patient ID's. The printed provider name is only necessary when the signature is illegible and there is a need to identify the provider. Which statements are TRUE regarding retrospective audits? - answer1.Can be performed by internal employees. 2.Can be performed by external consultants who sign a business agreement 3. Performed after data was submitted If a medical record has conflicting information documented, how is it resolved? - answerprovider is queried and an addendum/late entry is created to address the conflicting information. Patient diagnosed with severe protein calorie malnutrition. What is the appropriate diagnosis coding? - answerE43 Which ICD-10-CM code(s) is/are reported when the provider diagnoses the patient with adult attention deficit disorder (ADD)? - answerF98.8