CRC Quality of Care Measures 2

Question 1

How does accurate risk adjustment coding impact a Medicare Advantage plan's Star Rating?

Accepted Answer

Accurate coding ensures quality measure denominator populations are correctly identified

Answer

Accurate coding ensures patients are correctly identified for quality measure populations. Without it, quality performance appears artificially inflated.

Question 2

How does risk adjustment data quality affect the HEDIS Controlling High Blood Pressure measure?

Accepted Answer

Accurate hypertension coding ensures all hypertensive members are in the denominator

Answer

HEDIS CBP requires identifying all members with hypertension. If hypertension is uncoded for some members, the denominator is incomplete.

Question 3

What is the relationship between RAPS and EDS for risk adjustment?

Accepted Answer

RAPS submits diagnosis codes only; EDS submits complete encounter data for both risk adjustment and quality measurement

Answer

RAPS is diagnosis-only for risk adjustment. EDS submits complete encounter records supporting both risk adjustment and quality measurement.

Question 4

How can risk adjustment coding data support a heart failure readmission reduction initiative?

Accepted Answer

By identifying all HF members, their complication profiles, and risk stratification for targeted care management

Answer

Accurate coding creates a comprehensive dataset enabling risk stratification and targeted interventions.

Question 5

A plan's RAF scores increase year-over-year but health outcomes remain unchanged. What quality concern does this raise?

Accepted Answer

The pattern suggests coding intensity increases without corresponding clinical complexity changes

Answer

Rising scores without utilization/outcome changes suggests coding practice changes rather than true population health changes.

(CRC) Certified Risk Adjustment Coder Practice Test

(CRC) Certified Risk Adjustment Coder Practice Test

CRC Quality of Care Measures 2