Question 1

Which of the following contributes to the risk adjustment score under the CMS-HCC model?

Options :

A : Income status and disability status

B : Health status and previous risk score

C : Enrollment eligibility status and reported conditions

D : Cost of care provided and hospital readmissions

Answer: C

Question 2

A CDI specialist receives a call from a disgruntled provider regarding recent documentation queries.The provider claims to only have 15 minutes to see patients and does not have time for interruptionslike this if it does not increase reimbursement. Which of the following is the BEST course of action toeffectively facilitate communication?

Options :

A : Explain to the provider that queries may affect reimbursement, however not directly, and heshould comply.

B : Listen to the provider, agree this does not affect reimbursement, and explain that the CDI teamwill stop querying.

C : Request a time at the provider's convenience to review the query process and collaborate tofacilitate the best workflow.

D : Call the provider's superior and report him as being non-compliant with organizational processes.

Answer: C

Question 3

Documentation from which of the following facility settings contributes to the CMS-HCC risk score?

Options :

A : Freestanding ambulatory surgical center

B : Hospital ambulatory clinic

C : Hospice care

D : Renal dialysis center

Answer: B

Question 4

Which diagnosis and treatment plan may generate a query?

Options :

A : Prostate carcinoma and luteinizing hormone-releasing hormone

B : Atrial fibrillation and amiodarone

C : Malnutrition and parenteral nutrition

D : Severe major depressive disorder and immunotherapy

Answer: D

Question 5

A provider has been determined to be a high-cost provider after a total claims cost analysis. Theproviders patient panel has an overall low HCC average score. Which of the following is the MOSTlikely explanation regarding the low HCC average score?

Options :

A : The provider cares for patients of a higher acuity

B : The provider is failing to capture all relevant diagnoses

C : The provider has a less complex patient population

D : The provider is not reporting unspecified diagnoses

Answer: B

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