CRC PRACTICE EXAM 1 2024 ACTUAL EXAM
QUESTIONS WITH DETAILED VERIFIED
SOLUTIONS A+ GRADE ASSURED
Which of the following medications are prescribed to cancer patients to eradicate the
cancer or for prophylaxis?
• Tamoxifen
• Anastrozole
• Januvia
• Crestor - ANSWER I and II
The definition of a best medical record for a RADV audit is:
• Documentation validates the CMS requested HCCs, contains all the
necessary documentation elements and has an additional HCC not
requested by CMS
• Documentation that validates all the requested HCCs
• Documentation that validates the requested HCC, but there is no provider signature
• Documentation that validates the requested HCC plus validates an additional HCC,
contains all the necessary documentation elements, but is missing the provider signature,
for which a signed CMS attestation was provided but not signed by the provider -
ANSWER A.
Documentation validates the CMS requested HCCs, contains all the necessary
documentation elements and has an additional HCC not requested by CMS
Which of the following are reported by a provider for beneficiaries in a Medicare
Advantage Plan?
• Nature of the presenting problem
• Resolved conditions that have been treated in the past
• Family history for all conditions
• All chronic conditions - ANSWER I and IV
,Which of the following records would be a good source for a retrospective chart audit?
• DME documentation
• Cardiologist records
• Dietician notes
• RN notes - ANSWER B. Cardiologist records
Retrospective audits should include the following
attributes:
• Provider signatures
• Supporting documentation of the patient's diagnoses
• DOS
• I
• II
• I and II
• I, II and III - ANSWER D. I, II and III
Which type of audit evaluates appropriate risk scores of patients?
• ZPIC
• RADV
• RAC
• CERT - ANSWER B. RADV
What information is required when submitting documentation to support a diagnosis for a
RADV/IVA?
• All patient records for the calendar year resulting in care for a chronic condition
• All inpatient hospital records where a readmission occurred
• A single DOS for outpatient records and the full inpatient set for hospital records
,• All professional provider documentation for the previous year - ANSWER C. A single
DOS for outpatient records and the full inpatient set for hospital records
What is TRUE regarding the code assignment requirement for chronic kidney disease
requiring dialysis (N18.6)?
• The diagnosis should only be reported when the patient is admitted to the hospital.
• The diagnosis should only be reported when the patient is diagnosed with CKD and is
actively being treated by a specialist.
• The patient should be diagnosed with CKD and is on chronic dialysis or receiving
kidney transplants are associated with this diagnosis.
• The diagnosis should only be reported when the patient is diagnosed with chronic
renal insufficiency. - ANSWER C. The patient should be diagnosed with CKD and is
on chronic dialysis or receiving kidney transplants are associated with this diagnosis.
Joey is prescribed Oxycodone for a back injury by his orthopedic surgeon two years ago.
The surgeon documents he would like to try another medication to dull the pain. Joey
attempts to change to the newer medication but there is breakthrough pain and he goes
back to the Oxycodone. Would code from category F11.2 be appropriate?
• Yes, Joey has been on the Oxycodone for two years
• Yes, Joey's pain could not be controlled by the second medication
• No, a person must be on a medication a minimal of 3 years before "dependency" can
be implied
• No, the surgeon did not document that Joey was dependent on the Oxycodone - ANSWER
D. No, the surgeon did not document that Joey was dependent on the Oxycodone
Diagnoses must be based on face-to face encounters between members and an MD, PA, or
NP and status conditions like a below knee amputation, must be assessed and documented
in order for payment adjustments to be received. How often should a provider see and
assess a patient in a calendar year to validate amputation status?
• Twice a year
• Once a year
, • Four times a year
• Every two years - ANSWER B. Once a
year A PEG Tube is:
• Percutaneous Endoscopic Gastrostomy
• G tube
• Gastrostomy
• Colostomy
• I
• I and III
• I, II, and III
• IV - ANSWER C. I, II, and III
Patient is here for follow up. She was seen in the ER two weeks ago where she had an MRI
of the brain which showed significant cerebral arteriosclerosis. She was diagnosed with a
TIA. She has been experiencing slight memory loss. Select the correct code(s).
• I67.2, Z86.73
• G45.9
• Z86.73, R41.3
• G45.9, I67.2, R41.3 - ANSWER A. I67.2, Z86.73
Patient is here for follow up after her dialysis yesterday. What is the ICD-10-CM code for
presence of an AV fistula for dialysis?
• T82.818D
• I77.0
• Z49.31
QUESTIONS WITH DETAILED VERIFIED
SOLUTIONS A+ GRADE ASSURED
Which of the following medications are prescribed to cancer patients to eradicate the
cancer or for prophylaxis?
• Tamoxifen
• Anastrozole
• Januvia
• Crestor - ANSWER I and II
The definition of a best medical record for a RADV audit is:
• Documentation validates the CMS requested HCCs, contains all the
necessary documentation elements and has an additional HCC not
requested by CMS
• Documentation that validates all the requested HCCs
• Documentation that validates the requested HCC, but there is no provider signature
• Documentation that validates the requested HCC plus validates an additional HCC,
contains all the necessary documentation elements, but is missing the provider signature,
for which a signed CMS attestation was provided but not signed by the provider -
ANSWER A.
Documentation validates the CMS requested HCCs, contains all the necessary
documentation elements and has an additional HCC not requested by CMS
Which of the following are reported by a provider for beneficiaries in a Medicare
Advantage Plan?
• Nature of the presenting problem
• Resolved conditions that have been treated in the past
• Family history for all conditions
• All chronic conditions - ANSWER I and IV
,Which of the following records would be a good source for a retrospective chart audit?
• DME documentation
• Cardiologist records
• Dietician notes
• RN notes - ANSWER B. Cardiologist records
Retrospective audits should include the following
attributes:
• Provider signatures
• Supporting documentation of the patient's diagnoses
• DOS
• I
• II
• I and II
• I, II and III - ANSWER D. I, II and III
Which type of audit evaluates appropriate risk scores of patients?
• ZPIC
• RADV
• RAC
• CERT - ANSWER B. RADV
What information is required when submitting documentation to support a diagnosis for a
RADV/IVA?
• All patient records for the calendar year resulting in care for a chronic condition
• All inpatient hospital records where a readmission occurred
• A single DOS for outpatient records and the full inpatient set for hospital records
,• All professional provider documentation for the previous year - ANSWER C. A single
DOS for outpatient records and the full inpatient set for hospital records
What is TRUE regarding the code assignment requirement for chronic kidney disease
requiring dialysis (N18.6)?
• The diagnosis should only be reported when the patient is admitted to the hospital.
• The diagnosis should only be reported when the patient is diagnosed with CKD and is
actively being treated by a specialist.
• The patient should be diagnosed with CKD and is on chronic dialysis or receiving
kidney transplants are associated with this diagnosis.
• The diagnosis should only be reported when the patient is diagnosed with chronic
renal insufficiency. - ANSWER C. The patient should be diagnosed with CKD and is
on chronic dialysis or receiving kidney transplants are associated with this diagnosis.
Joey is prescribed Oxycodone for a back injury by his orthopedic surgeon two years ago.
The surgeon documents he would like to try another medication to dull the pain. Joey
attempts to change to the newer medication but there is breakthrough pain and he goes
back to the Oxycodone. Would code from category F11.2 be appropriate?
• Yes, Joey has been on the Oxycodone for two years
• Yes, Joey's pain could not be controlled by the second medication
• No, a person must be on a medication a minimal of 3 years before "dependency" can
be implied
• No, the surgeon did not document that Joey was dependent on the Oxycodone - ANSWER
D. No, the surgeon did not document that Joey was dependent on the Oxycodone
Diagnoses must be based on face-to face encounters between members and an MD, PA, or
NP and status conditions like a below knee amputation, must be assessed and documented
in order for payment adjustments to be received. How often should a provider see and
assess a patient in a calendar year to validate amputation status?
• Twice a year
• Once a year
, • Four times a year
• Every two years - ANSWER B. Once a
year A PEG Tube is:
• Percutaneous Endoscopic Gastrostomy
• G tube
• Gastrostomy
• Colostomy
• I
• I and III
• I, II, and III
• IV - ANSWER C. I, II, and III
Patient is here for follow up. She was seen in the ER two weeks ago where she had an MRI
of the brain which showed significant cerebral arteriosclerosis. She was diagnosed with a
TIA. She has been experiencing slight memory loss. Select the correct code(s).
• I67.2, Z86.73
• G45.9
• Z86.73, R41.3
• G45.9, I67.2, R41.3 - ANSWER A. I67.2, Z86.73
Patient is here for follow up after her dialysis yesterday. What is the ICD-10-CM code for
presence of an AV fistula for dialysis?
• T82.818D
• I77.0
• Z49.31
