HCC Coding/Risk Adjustment Exam Questions With Correct Answers
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Course
HCC Coding
Institution
HCC Coding
HCC Coding/Risk Adjustment Exam
Questions With Correct Answers
Risk Adjustment Model - answerCalculates risk scores for all beneficiaries with available
data
What are the three submission deadlines? - answer1. First Friday in September = Initial Risk
Score
2. First Friday in March = Mid-year ...
HCC Coding/Risk Adjustment Exam
Questions With Correct Answers
Risk Adjustment Model - answer✔✔Calculates risk scores for all beneficiaries with available
data
What are the three submission deadlines? - answer✔✔1. First Friday in September = Initial Risk
Score
2. First Friday in March = Mid-year Update
3. January 31 after the payment year = Final reconcilation
Medicare risk adjustment model is prospective. This means? - answer✔✔Diagnoses reported in
the prior year and demographic information are utilized to "predict" future costs and adjust
payments accordingly
Risk Scores. - answer✔✔Measures individual beneficiaries' relative risk and are used to adjust
payments for each beneficiary's expected expenditures.
FERAS Response Report. - answer✔✔Rejected data after it has been processed through FERAS
is recorded in this report.
RAPS Return File - answer✔✔This is a daily report that shows all records approved and where
errors occurred.
RAPS Transaction Error Report - answer✔✔Displays records on which errors occurred.
RAPS Transaction Summary Report - answer✔✔A report sent to the MA organization daily and
identifies data that have been finalized in RAPS database
Duplicate Diagnosis Cluster Report - answer✔✔Shows diagnosis clusters submitted with
information that duplicates a stored cluster.
RAPS Monthly Plan Activity Report and Cumulative Plan Activity Report - answer✔✔Provides
a summary of all diagnoses stored for a given time period.
Error Frequency Report - answer✔✔This report is distributed monthly and quarterly. Provides
an overview of all errors associated with files submitted in test and production.
RAPS database - answer✔✔Stores all finalized diagnosis clusters
Risk Adjustment System (RAS) - answer✔✔Executes the risk adjustment model and calculates
the risk score using the SAS model.
Medicare Advantage Prescription Drug System (MARx) - answer✔✔Processes payments to
plans and issues the MMR (Monthly Membership Report) and MOR (Model Output Report).
How often does CMS conduct data validation audits and for what purpose? - answer✔✔Audits
are done annually on selected plans that may have to request medical record documentation from
the providers to support the submitted diagnoses.
What types of data are checked in FERAS? - answer✔✔File-level, batch-level and first and last
detailed records
RAPS Return file - answer✔✔Daily reports that shows all records approved and where errors
occurred.
What does File-level information identified? - answer✔✔Submitter
What does Batch-level information identify? - answer✔✔MA organization
What does Detail-level information identify? - answer✔✔Beneficiary
Define Reconciliation - answer✔✔The completion of the implementation of payments with
CMS calculating final risk adjustment factors and beneficiary stats based on complete data.
Necessary adjustments for institutional status and demographic data for enrollees is considered.
CMS continues to allow a period (approximately 13 months after the data collection year) for
submitting final RAPS data for the appropriate data collection period.
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?
Septicemia (Category 380) - 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?
Heart Failure (Category 428) - 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?
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