CRC LATEST UPDATE 2024 EXAM / COMPLETE 300 ACTUAL
EXAM QUESTIONS WITH CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) GRADED A+
How is Medicare Funding allocated? - Correct Answer - Based on previous years known
dx (retrospective)
What data elements are used in predictive modeling? - Correct Answer - +DME claims
+RX events
+MD claims data
+Facility claims data
What are the domains in PQRS (Physician Quality Reporting System)? - Correct
Answer - +community population health
+effective clinical care
+efficiency & cost reduction
+patient safety
What is reported when the provider documents arrow up HTN - Correct Answer - query
MD
What is an acceptable signature? - Correct Answer - Handwritten
INPATIENT setting - how would you code uncertain dx?
(uncertain = probable, suspected, possible, questionable) - Correct Answer - Code the
condition as if it was established dx
pg. 1
,OUTPATIENT setting - how would you code an uncertain dx? - Correct Answer - code
as a sign or symptom or abnormal labs
When can hemiparesis be coded? - Correct Answer - +weakness on one side of body
+weakness on one side of body s/p CVA
How long can an addendum be added to documentation? - Correct Answer -
"reasonable time frame"/ 60 days
When does Medicare require the provider to sign the medical record? - Correct Answer
- "timely" basis
When are CA dx coded as "current"? - Correct Answer - When receiving treatment
Meds for CA to eradicate or for prophylaxis - Correct Answer - Tamoxifen, Anastrozole
When is it appropriate to use Hx of malignancy? - Correct Answer - +it has been
excised,
+no evidence of any existing primary malignancy
+there is no further tx directed to the site
Funding is allocated based on what for COMMERCIAL plans - Correct Answer - Current
year's dx
The Star Ratings program monitors? - Correct Answer - Performance of Medicare
Advantage Plans
Ratings are published by CMS in Oct.
What is True about the Star Quality Rating system? - Correct Answer - Quality bonus
payments are made to medicare advantage plans who score 5 or 4 stars
BONUS= 5 or 4
pg. 2
,In the Star Program what is the lowest rating a plan must achieve to avoid penalties? -
Correct Answer - 4
No Penalities = 5 > 4
Penalities = 1,2,3
*Pts enrolled in a poorly performing plan can switch an a 5-star plan at ANY time
In the Star program which measure is given the highest weight? - Correct Answer -
Outcomes
What is true regarding the Star Program? - Correct Answer - States can either use the
federal methodology OR
Propose an alternative for certification of HHS
What do the star ratings identify? - Correct Answer - top perfoming health plans based
on quality
What element of the medical record is NOT used to capture current dx? - Correct
Answer - Radiology report
What type of fracture is considered traumatic? - Correct Answer - compound fracture
When code for External Causes? - Correct Answer - Causes of injury or health condition
Which structure in the urinary system differs in position/length between males &
females? - Correct Answer - Urethra
urine is transported from kidneys to bladder via - Correct Answer - ureter
Where is bile produced? - Correct Answer - produced =liver
pg. 3
, stored= gall bladder
What belongs to the appendicular skeleton? - Correct Answer - pelvic girdle
which membrane is found lining the interior walls of the digestive system? - Correct
Answer - mucous
Medicare defaults much of its risk adjustment dx coding guidelines to: - Correct Answer
- Official Coding Guidelines, &
Coding Clinic
Coding Clinic is associated with? - Correct Answer - AHA (American Hosp. Assoc.)
What is the purpose of collecting dxs in risk adjustment coding? - Correct Answer - Risk
adjustment factor (RAF)
pg. 4
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