CRC Cheat Sheet 2026

The 30 highest-yield CRC facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. Supplemental data sources used in retrospective risk adjustment most commonly include which of the following? → Medical records, lab data, and pharmacy data reviewed outside the normal claims flow
2. What is a common example of a disease interaction in CMS-HCC, and how does it affect the RAF? → HCC pairs whose combination adds an incremental coefficient beyond individual HCC weights
3. What is the minimum coding intensity adjustment CMS applies to MA risk adjustment payments? → A mandatory 5.91% reduction to all MA risk scores to account for MA-FFS coding differences
4. The benchmark in Medicare Advantage is based on: → County-level fee-for-service Medicare spending rates
5. Which data visualization is most effective for presenting risk adjustment patterns to non-technical stakeholders? → Heat maps showing capture rates compared to benchmarks by provider
6. What is 'upcoding' in the context of Medicare Advantage? → Reporting higher-severity diagnoses than documented to inflate risk scores
7. A patient has major depressive disorder (HCC 59), drug use disorder (HCC 55), and alcohol use disorder (HCC 55). How does this affect the RAF? → Only one HCC 55 value is counted regardless of how many conditions map to it
8. An EHR assessment section contains 20+ conditions on the problem list but the plan section only addresses 5. Which conditions can be coded for risk adjustment? → Only the 5 conditions addressed in the plan section
9. How does risk adjustment data quality affect the HEDIS Controlling High Blood Pressure measure? → Accurate hypertension coding ensures all hypertensive members are in the denominator
10. A patient with Hb-SS sickle cell disease presents with acute chest syndrome and pain crisis. What is the correct coding? → D57.01 for acute chest syndrome, which encompasses the crisis state
11. Which encounter type is NOT acceptable for risk adjustment diagnosis submission? → Lab-only encounter with no face-to-face provider interaction
12. What is the primary file format used for submitting encounter data to CMS for Medicare Advantage? → ANSI X12 837 transaction format
13. What is the primary purpose of the RADV Fee-for-Service Adjuster? → To account for coding errors in the FFS benchmark that inflate the comparison baseline
14. A coder encounters a patient with both hepatitis C (HCC 29) and HIV (HCC 1). Both are documented as active. How does the CMS-HCC model handle this? → Both HCCs are counted independently since they belong to separate disease hierarchies
15. Which regulatory body has primary authority over Medicare Advantage risk adjustment compliance? → CMS through its Center for Program Integrity
16. What does CMS set to ensure MA plans submit a sufficient volume of encounter data? → Minimum encounter data submission rate floors
17. Which compliance safeguard is most critical when using chart review vendors for retrospective risk adjustment coding? → Prohibiting vendors from being compensated based on HCCs identified
18. A chart contains photocopied documents from an outside provider. Can these be used for risk adjustment coding? → They can be used if incorporated into the record and acknowledged by the treating provider
19. What federal agency enforces healthcare fraud and abuse laws? → OIG
20. How does the CMS-HCC model handle institutional vs community-dwelling beneficiaries? → Separate model segments with different coefficients for each population
21. What is a risk score in the context of risk adjustment? → Predicted cost of care
22. How did CMS-HCC V28 change substance use disorder categorization? → V28 created more granular categories differentiating by substance type and severity
23. A provider's assessment says 'COPD' but pulmonary function tests show normal spirometry. How should the CRC handle this? → Query the provider to reconcile the assessment with test results
24. Which section of the ICD-10-CM guidelines addresses outpatient coding? → Section IV
25. Which of the following statements is TRUE regarding the coding of chronic conditions for risk adjustment purposes? → All co-existing chronic conditions that affect patient care can be reported annually.
26. A provider documents 'uncontrolled diabetes.' What code should be assigned? → E11.65 for diabetes with hyperglycemia
27. Which of the following is a risk associated with relying solely on retrospective chart reviews for risk adjustment? → Diagnoses found may lack face-to-face encounter documentation required by CMS
28. Which part of the record is most often used for abstracting diagnoses? → Assessment and plan notes
29. 12% of submitted codes come from encounters where the provider specialty does not typically diagnose the condition. What does this suggest? → The finding warrants investigation for possible copy-forward artifacts
30. Which type of diagnosis is typically captured in an HCC? → Chronic or severe conditions