CRC EXAM LATEST VERSION 2025/2026 FOR A
GUARANTEED PASS
Risk Adjustment Data Element - ANS -Age, Gende, Socioeconomic status, Disability
status, Insurance status(Medicaid, dual-eligible,) Claims data elements such as
procedure codes, place of service codes, special patient-specific conditions
hospice, ESRD
RAF - ANS -Risk Adjustment Factor Scores
Three main types of reviews - ANS -Retrospective, Concurrent and prospective
Retrospective - ANS -reviews are performed after the information has been
reported and in risk adjustment these are prior years dos
Concurrent reviews - ANS -performed ongoing as patients are seen prior to
reporting and in risk adjustment the current year
Prospective reviews - ANS -will effect the next year and not the current year
where payment is concerned. They are used to forcast
Types of Risk Adjustment Models(HHS) - ANS -HHS hEALTH AND HUMAN SERVICES
hIERARCHICAL CONDITION(Commercial, individual and small grooup
, Types of Risk Adjustment Modles(CDPS) - ANS -Chronic Illness and Disability
payment systems(Medicaid)
Types of Risk Adjustment Models(HCC-C) - ANS -Hierarchical Condition Category,
Part C
Types of Risk Adjustment model (DRG) - ANS -Diagnosis Related Group (Inpatient)
Types of Risk Adjustment model (ACG) - ANS -Adjusted Clinical Groups(Outpatient)
Prescription based program risk adjustment examples:UCSD - ANS -Medicaid
Rx(UCSD)
Prescription based program risk adjustment examples(Dxcg) - ANS -
RxGroups(DxCG)
Prescription based program risk adjustment examples(HCC-D) - ANS -Hierarchical
Condition Category, Part D(HCC-D
Trump List - ANS -Families or hierarchies set a value base on severity of illness
with more severe diagnoses carrying the overall risk score for that family.
Stage 1 Pressure Ulcer - ANS -Persistent focal erythema
GUARANTEED PASS
Risk Adjustment Data Element - ANS -Age, Gende, Socioeconomic status, Disability
status, Insurance status(Medicaid, dual-eligible,) Claims data elements such as
procedure codes, place of service codes, special patient-specific conditions
hospice, ESRD
RAF - ANS -Risk Adjustment Factor Scores
Three main types of reviews - ANS -Retrospective, Concurrent and prospective
Retrospective - ANS -reviews are performed after the information has been
reported and in risk adjustment these are prior years dos
Concurrent reviews - ANS -performed ongoing as patients are seen prior to
reporting and in risk adjustment the current year
Prospective reviews - ANS -will effect the next year and not the current year
where payment is concerned. They are used to forcast
Types of Risk Adjustment Models(HHS) - ANS -HHS hEALTH AND HUMAN SERVICES
hIERARCHICAL CONDITION(Commercial, individual and small grooup
, Types of Risk Adjustment Modles(CDPS) - ANS -Chronic Illness and Disability
payment systems(Medicaid)
Types of Risk Adjustment Models(HCC-C) - ANS -Hierarchical Condition Category,
Part C
Types of Risk Adjustment model (DRG) - ANS -Diagnosis Related Group (Inpatient)
Types of Risk Adjustment model (ACG) - ANS -Adjusted Clinical Groups(Outpatient)
Prescription based program risk adjustment examples:UCSD - ANS -Medicaid
Rx(UCSD)
Prescription based program risk adjustment examples(Dxcg) - ANS -
RxGroups(DxCG)
Prescription based program risk adjustment examples(HCC-D) - ANS -Hierarchical
Condition Category, Part D(HCC-D
Trump List - ANS -Families or hierarchies set a value base on severity of illness
with more severe diagnoses carrying the overall risk score for that family.
Stage 1 Pressure Ulcer - ANS -Persistent focal erythema
