Question 1

Which of the following physician performance metrics BEST illustrates provider engagement withoutpatient CDI specialist?

Options :

A : Query response rates and problem list updates

B : Problem list updates and RAF capture rates

C : Physician MIPS scores and query response rates

D : Physician RAF scores and RAF capture rates

Answer: A

Question 2

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 3

Which of the following acronyms is often used in considering reportability of conditions?

Options :

A : OPPS

B : MEAT

C : MACRA

D : RADV

Answer: B

Question 4

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

Question 5

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