CRC - Certified Risk Adjustment Coder Quality of Care Measures Questions and Answers

Question 1

A health plan is evaluated on the percentage of its diabetic members who receive an annual eye exam. This is an example of which type of quality of care measure?

Accepted Answer

Process measure

Answer

Structural measure

Answer

Outcome measure

Answer

Balancing measure

Question 2

Which of the following is a primary goal of the Healthcare Effectiveness Data and Information Set (HEDIS)?

Accepted Answer

To provide a standardized method for health plans to measure performance and quality of care.

Answer

To calculate risk adjustment payment models for individual providers.

Answer

To mandate specific electronic health record (EHR) software for all healthcare organizations.

Answer

To directly audit and correct individual patient medical records for coding errors.

Question 3

A Medicare Advantage plan's hospital readmission rate for patients with congestive heart failure would be classified as what type of quality measure?

Accepted Answer

Outcome measure

Answer

Process measure

Answer

Structural measure

Answer

Patient experience measure

Question 4

A risk adjustment coder notices that the documentation for a patient with diabetes consistently lacks the results of an annual kidney health evaluation. This missing information directly impacts which two areas?

Accepted Answer

Hierarchical Condition Category (HCC) capture and HEDIS measures

Answer

HHS-HCC and Medicaid audits

Answer

Physician reimbursement and hospital accreditation

Answer

CPT coding and patient satisfaction scores

Question 5

The Medicare Star Ratings program uses quality of care measures to assess Medicare Advantage plans. Which of the following domains is NOT typically a core component of the Star Ratings?

Accepted Answer

Provider and staff compensation rates

Answer

Staying healthy (preventive screenings and vaccines)

Answer

Managing chronic (long-term) conditions

Answer

Member experience with the health plan

Question 6

A health plan implements a new program to reduce 30-day hospital readmissions. They successfully lower the readmission rate (an outcome measure) but notice a significant drop in patient satisfaction scores because patients feel they are being discharged too quickly. This drop in satisfaction would be considered what type of measure?

Accepted Answer

A balancing measure

Answer

A structural measure

Answer

A concurrent measure

Answer

A process measure