CRC Practice Exam C with Accurate
Solutions
Do the HCC category hierarchies play a role in which medical record to submit for a
RADV?
I. No, there are no benefits in taking hierarchies into consideration
II. No, CMS will treat all diagnosis with the same financial weight
III. Yes, CMS will accept a lower or higher HCC to validate an HCC within the same
category
IV. Yes, there can be a financial gain by submitting a higher hierarchy HCC - ANS-III
and IV
CMS states for HCCs in a Hierarchy category can be submitted; either of lower risk
score or higher risk score.
Retrospective audits provide insurance companies with ability to scrub/correct their data
which accomplishes which of the following?
I. Provides opportunities to increase revenue by submitting additional codes
II. Provides opportunities to compare claims data to the documentation and submit
deletions if the documentation does not support what was on the claim
III. Provides opportunities to correct coding errors prior to data being submitted - ANS-I
and II
Retrospective chart audits have been commonly used to increase revenue, but for
companies that want to do the "right" thing and to decrease the financial risk during
RADV audits, comparing the claims to the documentation and where there are
discrepancies submit deletes (remove ICD-10-CM code from CMS data base) and to
submit additional codes is the best use of the retrospective chart audits.
Which of the following is an example of fraud?
A. Reporting a diabetic manifestation to increase the risk score.
B. Submitting a record for a RADV audit which includes diagnoses that were not
previously reported.
C. Training physicians to document causal relationships for manifestations for chronic
illnesses when present.
D. Setting a policy to report all patient's with DM and CKD as a diabetic manifestation. -
ANS-A
Intentionally reporting a diagnosis that is not supported by the documentation in order to
raise a risk score is fraud.
Risk Adjustment is a:
A. Prospective payment system
B. Retrospective payment system
, C. Fee-for-service payment system
D. Case rate payment system - ANS-A
Risk adjustment is a prospective payment model. It uses diagnostic information from a
base year to predict Medicare benefit costs for the following year.
Choose the best medical record for a RADV audit to include all the diagnoses in this
scenario:• CMS is requesting diabetes mellitus with neuropathy to be validated• Assume
all the notes are signed by the provider and the diagnoses are supported by the
documentation
A. Chart #1: DOS 1/1/20XX—Diagnoses: DM, PVD
B. Chart #2: DOS 4/2/20XX—Diagnoses: DM with neurologic manifestations,
polyneuropathy, CKD
C. Chart # 3: DOS 7/7/20XX—Diagnoses: DM with neurologic manifestations
D. Chart # 4: DOS 9/9/20XX—Diagnosis: DM, HTN - ANS-B
When a diabetic manifestation is reported a combination code is used to include the
type of diabetes and the manifestation. The record that supports the condition in
question is chart #2.
Which of the following is appropriate to assign ICD-10-CM code N18.9?I. Chronic Renal
DiseaseII. Chronic Renal FailureIII. Chronic Kidney Disease UnspecifiedIV. Chronic
Renal Insufficiency
A. I
B. I, II, and IV
C. III
D. I, II, III, and IV - ANS-D
Answer III is correct because it is included in the description of ICD-10-CM code N18.9.
Answers I, II, and IV are the listed under the Inclusion Terms under code N18.9 and
therefore also correct.
Patient is admitted to the hospital for treatment of a Subarachnoid Hemorrhage. The
patient has hypertension and is being evaluated by Neurosurgery for possible surgical
intervention. Assign the correct ICD-10-CM code(s) for the admission.
A. I60.9, I10
B. I10, I60.9
C. I60.9
D. I61.9, I10 - ANS-A
There is an instructional note under category I60-I69 in the Tabular List that indicates to
use additional code to identify presence of hypertension.
Chronic and acute conditions/diagnoses from the previous year that Risk Adjust are
used to establish reimbursement for patient care provided by the MA plan. Which of the
following statements is TRUE?
A. HCCs must be captured every 12 months for CMS to reimburse/ DM with a
manifestation (complication) requires that you document and code the manifestation as
well
Solutions
Do the HCC category hierarchies play a role in which medical record to submit for a
RADV?
I. No, there are no benefits in taking hierarchies into consideration
II. No, CMS will treat all diagnosis with the same financial weight
III. Yes, CMS will accept a lower or higher HCC to validate an HCC within the same
category
IV. Yes, there can be a financial gain by submitting a higher hierarchy HCC - ANS-III
and IV
CMS states for HCCs in a Hierarchy category can be submitted; either of lower risk
score or higher risk score.
Retrospective audits provide insurance companies with ability to scrub/correct their data
which accomplishes which of the following?
I. Provides opportunities to increase revenue by submitting additional codes
II. Provides opportunities to compare claims data to the documentation and submit
deletions if the documentation does not support what was on the claim
III. Provides opportunities to correct coding errors prior to data being submitted - ANS-I
and II
Retrospective chart audits have been commonly used to increase revenue, but for
companies that want to do the "right" thing and to decrease the financial risk during
RADV audits, comparing the claims to the documentation and where there are
discrepancies submit deletes (remove ICD-10-CM code from CMS data base) and to
submit additional codes is the best use of the retrospective chart audits.
Which of the following is an example of fraud?
A. Reporting a diabetic manifestation to increase the risk score.
B. Submitting a record for a RADV audit which includes diagnoses that were not
previously reported.
C. Training physicians to document causal relationships for manifestations for chronic
illnesses when present.
D. Setting a policy to report all patient's with DM and CKD as a diabetic manifestation. -
ANS-A
Intentionally reporting a diagnosis that is not supported by the documentation in order to
raise a risk score is fraud.
Risk Adjustment is a:
A. Prospective payment system
B. Retrospective payment system
, C. Fee-for-service payment system
D. Case rate payment system - ANS-A
Risk adjustment is a prospective payment model. It uses diagnostic information from a
base year to predict Medicare benefit costs for the following year.
Choose the best medical record for a RADV audit to include all the diagnoses in this
scenario:• CMS is requesting diabetes mellitus with neuropathy to be validated• Assume
all the notes are signed by the provider and the diagnoses are supported by the
documentation
A. Chart #1: DOS 1/1/20XX—Diagnoses: DM, PVD
B. Chart #2: DOS 4/2/20XX—Diagnoses: DM with neurologic manifestations,
polyneuropathy, CKD
C. Chart # 3: DOS 7/7/20XX—Diagnoses: DM with neurologic manifestations
D. Chart # 4: DOS 9/9/20XX—Diagnosis: DM, HTN - ANS-B
When a diabetic manifestation is reported a combination code is used to include the
type of diabetes and the manifestation. The record that supports the condition in
question is chart #2.
Which of the following is appropriate to assign ICD-10-CM code N18.9?I. Chronic Renal
DiseaseII. Chronic Renal FailureIII. Chronic Kidney Disease UnspecifiedIV. Chronic
Renal Insufficiency
A. I
B. I, II, and IV
C. III
D. I, II, III, and IV - ANS-D
Answer III is correct because it is included in the description of ICD-10-CM code N18.9.
Answers I, II, and IV are the listed under the Inclusion Terms under code N18.9 and
therefore also correct.
Patient is admitted to the hospital for treatment of a Subarachnoid Hemorrhage. The
patient has hypertension and is being evaluated by Neurosurgery for possible surgical
intervention. Assign the correct ICD-10-CM code(s) for the admission.
A. I60.9, I10
B. I10, I60.9
C. I60.9
D. I61.9, I10 - ANS-A
There is an instructional note under category I60-I69 in the Tabular List that indicates to
use additional code to identify presence of hypertension.
Chronic and acute conditions/diagnoses from the previous year that Risk Adjust are
used to establish reimbursement for patient care provided by the MA plan. Which of the
following statements is TRUE?
A. HCCs must be captured every 12 months for CMS to reimburse/ DM with a
manifestation (complication) requires that you document and code the manifestation as
well
