HCC Coding/Risk Adjustment questions and answers graded a+ 100%
verified \\\ pass!!!
Acute Kidney Failure, Chronic Kidney Disease (Categories 584-585) - answer-Probably
Forever/Almost ALLS
Is this condition a Probably Forever/Almost ALLS (still has condition even though
mediation or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
Amputations, Organ Transplant, History of MI - answer-Probably Forever/Almost ALLS
Is this condition a Probably Forever/Almost ALLS (still has condition even though
mediation or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
Alcoholism in Remission - answer-Probably Forever/Almost ALLS
Is this condition a Probably Forever/Almost ALLS (still has condition even though
mediation or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
Schizoprenia - answer-Probably Forever/Almost ALLS
Is this condition a Probably Forever/Almost ALLS (still has condition even though
mediation or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
CHF (compensated) - answer-Probably Forever/Almost ALLS
Is this condition a Probably Forever/Almost ALLS (still has condition even though
mediation or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
Residual Late Effects of Stroke - answer-Forever/ALLS
Is this condition a Probably Forever/Almost ALLS (still has condition even though
mediation or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
Upper Limb Amputation status - answer-Forever/ALLS
, Is this condition a Probably Forever/Almost ALLS (still has condition even though
mediation or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
Lower limb amputation status (including toe) - answer-Forever/ALLS
Is this condition a Probably Forever/Almost ALLS (still has condition even though
mediation or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
Malignant Neoplasm (except skin and lip) but including melanoma - answer-
Forever/ALLS
Define Moderate Risk - answer-One or more chronic illnesses with mild exacerbation,
progression or side effects of treatment
Two or more chronic stable illnesses
Define High Risk - answer-One or more chronic illnesses with severe exacerbation,
progression or side effects of treatment
Acute or Chronic illnesses or injuries that pose a threat to life or body function
In HCC coding the payment to the Health Plan is based on? - answer-Risk Score,
which is determined through diagnosis coding
What if the average risk score CMS suggest for an average healthy senior? - answer-
1.00
What does a risk score above 1.00 suggest? - answer-A patient with chronic conditions
A lower RAF Score may indicate (3 things)? - answer-1. false information due to lack of
adequate chart documentation or incomplete and/or inaccurate ICD coding
2. Patients not seen
3. Indicative of insufficient claims data submission
What is the another name for the RxHCC model? - answer-Plan Liability Model
What are the 4 key components (combination of measures) of a RAF Score? - answer-
1. Accurate coding and capture of all chronic conditions
2. Only the physician or NPP can document in the patient chart.
3. At minimum, diagnosis/HCC codes should be captured every 6 months.
4. CMS "drops" the codes from the prior year every December 31 and starts over again
with each member's conditions for the new year.
verified \\\ pass!!!
Acute Kidney Failure, Chronic Kidney Disease (Categories 584-585) - answer-Probably
Forever/Almost ALLS
Is this condition a Probably Forever/Almost ALLS (still has condition even though
mediation or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
Amputations, Organ Transplant, History of MI - answer-Probably Forever/Almost ALLS
Is this condition a Probably Forever/Almost ALLS (still has condition even though
mediation or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
Alcoholism in Remission - answer-Probably Forever/Almost ALLS
Is this condition a Probably Forever/Almost ALLS (still has condition even though
mediation or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
Schizoprenia - answer-Probably Forever/Almost ALLS
Is this condition a Probably Forever/Almost ALLS (still has condition even though
mediation or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
CHF (compensated) - answer-Probably Forever/Almost ALLS
Is this condition a Probably Forever/Almost ALLS (still has condition even though
mediation or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
Residual Late Effects of Stroke - answer-Forever/ALLS
Is this condition a Probably Forever/Almost ALLS (still has condition even though
mediation or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
Upper Limb Amputation status - answer-Forever/ALLS
, Is this condition a Probably Forever/Almost ALLS (still has condition even though
mediation or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
Lower limb amputation status (including toe) - answer-Forever/ALLS
Is this condition a Probably Forever/Almost ALLS (still has condition even though
mediation or device is covering up symptoms), Forever/ALLS, or a Chronic condition?
Malignant Neoplasm (except skin and lip) but including melanoma - answer-
Forever/ALLS
Define Moderate Risk - answer-One or more chronic illnesses with mild exacerbation,
progression or side effects of treatment
Two or more chronic stable illnesses
Define High Risk - answer-One or more chronic illnesses with severe exacerbation,
progression or side effects of treatment
Acute or Chronic illnesses or injuries that pose a threat to life or body function
In HCC coding the payment to the Health Plan is based on? - answer-Risk Score,
which is determined through diagnosis coding
What if the average risk score CMS suggest for an average healthy senior? - answer-
1.00
What does a risk score above 1.00 suggest? - answer-A patient with chronic conditions
A lower RAF Score may indicate (3 things)? - answer-1. false information due to lack of
adequate chart documentation or incomplete and/or inaccurate ICD coding
2. Patients not seen
3. Indicative of insufficient claims data submission
What is the another name for the RxHCC model? - answer-Plan Liability Model
What are the 4 key components (combination of measures) of a RAF Score? - answer-
1. Accurate coding and capture of all chronic conditions
2. Only the physician or NPP can document in the patient chart.
3. At minimum, diagnosis/HCC codes should be captured every 6 months.
4. CMS "drops" the codes from the prior year every December 31 and starts over again
with each member's conditions for the new year.
