CRC EXAM QUESTIONS AND ANSWERS
GRADED A+ 2025/2026
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
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, 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
stage 2 pressure ulcer - ANS Partial thickness skin loss involving epidermis, dermis, or both
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
GRADED A+ 2025/2026
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
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, 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
stage 2 pressure ulcer - ANS Partial thickness skin loss involving epidermis, dermis, or both
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
