CRC Practice Exam Questions And
Answers.
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 -
\III and IV
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 -
\I and II
Which on of the following is an example of fraud? -
\Reporting a diabetic manifestation to increase the risk score.
Medicare Risk Adjustment is a: -
\Prospective payment system
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 -
\Chart #2: DOS 4/2/20XX—Diagnoses: DM with neurologic manifestations,
polyneuropathy, CKD
Which statement is TRUE regarding RADV audits? -
\The purpose is to validate submitted HCC data
During a retrospective chart audit for a XYZ Medicare Advantage Company, it is
determined a diagnosis submitted is not supported by medical record. There is no
additional information to validate the diagnosis. The member is part of a health plan that
has 1,500 members and the insurance company received $350 for this diagnosis. This
HCC is chosen for a RADV audit. Using the CMS extrapolation methodology, how much
could the company have saved if it deleted this code during the retrospective chart audit
process? -
Answers.
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 -
\III and IV
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 -
\I and II
Which on of the following is an example of fraud? -
\Reporting a diabetic manifestation to increase the risk score.
Medicare Risk Adjustment is a: -
\Prospective payment system
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 -
\Chart #2: DOS 4/2/20XX—Diagnoses: DM with neurologic manifestations,
polyneuropathy, CKD
Which statement is TRUE regarding RADV audits? -
\The purpose is to validate submitted HCC data
During a retrospective chart audit for a XYZ Medicare Advantage Company, it is
determined a diagnosis submitted is not supported by medical record. There is no
additional information to validate the diagnosis. The member is part of a health plan that
has 1,500 members and the insurance company received $350 for this diagnosis. This
HCC is chosen for a RADV audit. Using the CMS extrapolation methodology, how much
could the company have saved if it deleted this code during the retrospective chart audit
process? -
