CRC Risk Adjustment Models & HCCs

Question 1

What does HCC stand for in risk adjustment coding?

Accepted Answer

Hierarchical Condition Category

Answer

Health Care Code

Answer

Hospital Care Category

Answer

Health Compliance Category

Question 2

What is the purpose of a risk adjustment model?

Accepted Answer

Ensure fair payment based on patient health

Answer

Increase hospital visits

Answer

Maximize coding errors

Answer

Promote unnecessary services

Question 3

Which type of diagnosis is typically captured in an HCC?

Accepted Answer

Chronic or severe conditions

Answer

Self-resolving illness

Answer

Minor injuries

Answer

Vaccination history

Question 4

What is a risk score in the context of risk adjustment?

Accepted Answer

Predicted cost of care

Answer

Test result

Answer

Medical error rate

Answer

Appointment frequency

Question 5

Which organization is primarily responsible for maintaining the CMS-HCC model?

Accepted Answer

CMS

Answer

FDA

Answer

CDC

Answer

AMA

Question 6

What coding principle is critical when submitting an HCC diagnosis?

Accepted Answer

Document MEAT criteria (Monitored, Evaluated, Assessed, Treated)

Answer

Use of highest-paying code

Answer

Always use unspecified codes

Answer

Rely on patient recall