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AAPC CRC EXAMS STUDY GUIDE 2025 QUESTIONS ANSD SOLUTIONS RATED A+, Exams of Business and Labour Law

Liberty University (LU)Business and Labour Law

✔✔what is coding - ✔✔translating a written or dictated medical record into a series of alphanumeric codes ✔✔which organ is in the thoracic cavity - ✔✔lungs ✔✔what does the term distal indicate - ✔✔farther from the point of attachment ✔✔blood is received back into the left atrium of the heart through.... - ✔✔pulmonary veins ✔✔the root of the nail is also known as what - ✔✔germinal matrix ✔✔the documentation states: Past Surgical history: she had a lumpectomy of the breast for DCIS 12 years ago which successfully eradicated the CA how would this be reported - ✔✔personal history of breast cancer ✔✔the documentation states: soft druse, some calcified what system would have this documentation - ✔✔ocular ✔✔which organ does pulmonary refer to - ✔✔lungs

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2024/2025

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AAPC CRC EXAMS STUDY GUIDE 2025 QUESTIONS ANSD
SOLUTIONS RATED A+
✔✔what is coding - ✔✔translating a written or dictated medical record into a series of
alphanumeric codes
✔✔which organ is in the thoracic cavity - ✔✔lungs
✔✔what does the term distal indicate - ✔✔farther from the point of attachment
✔✔blood is received back into the left atrium of the heart through.... - ✔✔pulmonary
veins
✔✔the root of the nail is also known as what - ✔✔germinal matrix
✔✔the documentation states: Past Surgical history: she had a lumpectomy of the breast
for DCIS 12 years ago which successfully eradicated the CA
how would this be reported - ✔✔personal history of breast cancer
✔✔the documentation states: soft druse, some calcified
what system would have this documentation - ✔✔ocular
✔✔which organ does pulmonary refer to - ✔✔lungs
✔✔what is a PEG tube - ✔✔a tube inserted into the stomach for long term feeding
✔✔angina pectoris refers to which system - ✔✔cardiovascular
✔✔what is cholelithiasis - ✔✔stones in the gallbladder
✔✔which risk adjustment model is typically used for medicaid patients - ✔✔chronic
illness and disability payment systems (CDPS)
✔✔which of the following providers are approved for diagnosis code capture under the
medicare HCC model
I - general surgeon
II - cardiologist
III - certified registered nurse anesthetist
IV - massage therapist
V - neuropsychiatrist - ✔✔I: General Surgeon
II : Cardiologist
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AAPC CRC EXAMS STUDY GUIDE 2025 QUESTIONS ANSD

SOLUTIONS RATED A+

✔✔what is coding - ✔✔translating a written or dictated medical record into a series of alphanumeric codes ✔✔which organ is in the thoracic cavity - ✔✔lungs ✔✔what does the term distal indicate - ✔✔farther from the point of attachment ✔✔blood is received back into the left atrium of the heart through.... - ✔✔pulmonary veins ✔✔the root of the nail is also known as what - ✔✔germinal matrix ✔✔the documentation states: Past Surgical history: she had a lumpectomy of the breast for DCIS 12 years ago which successfully eradicated the CA how would this be reported - ✔✔personal history of breast cancer ✔✔the documentation states: soft druse, some calcified what system would have this documentation - ✔✔ocular ✔✔which organ does pulmonary refer to - ✔✔lungs ✔✔what is a PEG tube - ✔✔a tube inserted into the stomach for long term feeding ✔✔angina pectoris refers to which system - ✔✔cardiovascular ✔✔what is cholelithiasis - ✔✔stones in the gallbladder ✔✔which risk adjustment model is typically used for medicaid patients - ✔✔chronic illness and disability payment systems (CDPS) ✔✔which of the following providers are approved for diagnosis code capture under the medicare HCC model I - general surgeon II - cardiologist III - certified registered nurse anesthetist IV - massage therapist V - neuropsychiatrist - ✔✔I: General Surgeon II : Cardiologist

III: Certified Registered Nurse Anesthetist V: Neuropsychiatrist ✔✔true or false: retrospective reviews are performed after the face to face visit but before the visit is finalized - ✔✔false ✔✔all risk adjustment models use diagnosis codes to determine potential patient-level risks. what additional elements are taken into consideration I - age II - insurance status III - claims data elements IV - ethnicity V - socioeconomic status - ✔✔I: age II: insurance status III: claims data elements V: socioeconomic status ✔✔true or false: the CMS national average risk score varies each year - ✔✔false ✔✔which type of review includes a review of current year combined with the prior year's dates of service - ✔✔concurrent review ✔✔which risk adjustment model is typically used for patients enrolled in a commercial plan through a healthcare exchange? - ✔✔Health and Human Services Hierarchical Condition Category (HHS HCC) ✔✔which risk adjustment model is used for patients enrolled in medicare advantage plan - ✔✔Medicare Hierarchal Condition Category (CMS HCC-C) ✔✔the affordable care act set a requirement for CMS to make quality bonus payments to medicare advantage plans based on the plans quality rating. the publicly available rating used for this is - ✔✔STARS ✔✔what is predictive modeling in risk adjustment - ✔✔an analytical review of known data elements to establish a hypothesis related to the future needs of patients ✔✔data elements used for predictive modeling include I - claims data II - prescription drug events III - procedures coded IV - durable medical equipment - ✔✔I: claims data II: prescription drug events

I - administrative measures II - qualified clinical data registry (QCDR) III - MIPS clinical quality measures (CQMs) IV - electronic clinical quality measures (eCOMs) V - medicare part b claims measures VI - consumer assessment of healthcare providers & systems (CAHPS) for MIPS survey VII - CMS web interface measures - ✔✔I: Admin measures IV: electronic clinical quality measures (eCOMs) V: Medicare Part B claims measures VII: CMS web interface measures ✔✔which MIPS performance category promotes the secure exchange of health information and the use of certified electronic health record technology (CEHRT) for coordination of care - ✔✔promoting interoperability ✔✔what is an alternative payment model (APM) - ✔✔a group of clinicians who have created a medicare advantage organization that utilizes only providers affiliated with their group ✔✔for a RADV audit, which records are sent from the health plan to CMS - ✔✔the 5 best records to support the diagnosis submitted for that beneficiary ✔✔true or false: many diagnoses are missed in physician coding because diagnoses are reported from the assessment portion of a visit instead of throughout the medical record for that visit - ✔✔true ✔✔what are the documentation standards when sending in medical records for a RADV audit I - legible II - complete III - face-to-face encounter IV - provided by an approved provider - ✔✔I: Legible II: Complete III: Face-to-face encounter IV: provided by an approved provider ✔✔what is an IVA and what is the IVAs function - ✔✔initial validation auditor; a third- party vendor, chosen by the health plan, to conduct a coding review and an enrollment review ✔✔when does CMS RADV typically occur - ✔✔2 to 3 years after payment ✔✔when does HHS HRADV typically occur - ✔✔ 6 - months after year-end

✔✔what were accountable care organizations designed for - ✔✔improve the quality of healthcare and lower costs ✔✔true or false: CMS RADV uses a stratified sample of three strata - ✔✔true ✔✔true or false: risk adjustment scores should not be used as a driver for provider behavior - ✔✔true ✔✔which interaction options enable an added value in the CMS HCC model I - a high-risk disease II - 2 diseases III - 3 diseases IV - disability alone V - disability and a disease - ✔✔II: 2 diseases III: 3 diseases V: disability and a disease ✔✔true or false: inpatient records are not required to be face-to-face encounters - ✔✔false ✔✔what must be included on a discharge summary submitted as a physician provider type - ✔✔the discharge date ✔✔true or false: diagnoses listed in a diagnostic report should be reported when documented as relevant by the provider in the documentation for face-to-face encounter

  • ✔✔true ✔✔true or false: chronic conditions reported in the past medical history can be coded for risk adjustment if there is documentation supporting current treatment - ✔✔true ✔✔true or false: attestations are not required for inpatient records - ✔✔true ✔✔what record would cause concern during a RADV audit - ✔✔a record from a pathologist that did not see the patient ✔✔medicare recognizes that certain conditions are chronic and ongoing conditions usually treated by ongoing medication management. these conditions have the potential for acute exacerbation if not treated properly. which of the options below are examples of these types of conditions I - COPD II - Chronic heart failure III - pneumonia

c - the provider must see the patient within seven days of the phone call for the diagnosis to be reportable for risk adjustment d - the diagnosis must be supported by a face-to-face encounter for the diagnosis to be reported for risk adjustment - ✔✔D: the diagnosis must be supported by a face-to-face encounter for the diagnosis to be reported for risk adjustment ✔✔true or false: diagnosis listed in the pmh should not be reported when they no longer exist - ✔✔true ✔✔true or false: for a condition within a problem list to be considered for a RADV purposes, it is necessary for a provider to document its relevance to the current encounter - ✔✔true ✔✔dr smith is engaging with the MA regarding his approach to the using the new EHR in the office for recording diagnosis codes with no documentation. the doctor continues to only report diagnosis codes instead of a legible description of the diagnosis. in the follow-up conversation with the MA , how should this be addressed - ✔✔dr smith is asked to document a legible description of the diagnosis code and is provided documentation from the coding clinic ✔✔documentation states, " the patient reports worsening dyspnea on exertion over the past year. she currently can walk one-half block on a flat surface before developing SOB and up one-half flight of stairs. these symptoms are often accompanied by upper back and neck pain and relieved with rest. she denies any chest pain, PND, orthopnea, palpitations, or syncopal spells what does the acronym PND refer to in this context - ✔✔a respiratory disorder ✔✔true or false: HIV/AIDS is most commonly transmitted by coughing - ✔✔false ✔✔insurance companies use a statistical process in which historical data is analyzed using algorithms to determine the likelihood of a future event. what is this process called

  • ✔✔predictive modeling ✔✔data is mined from various places to give additional information as it relates to risk scores. which of the following data elements might be used for predictive modeling I - durable medical equipment requests II - claims data (CPT, HCPCS level II, icd- 10 - cm, etc) III - prescription drug events - ✔✔I: durable medical equipment requests II: claims data III: prescription drug events ✔✔insurance companies use predictive modeling for:

I - recuperate money from the provider II - uncover potential current diagnoses that have not been reported on claims III - prepare for future needs of its members IV - provider education V - pay providers for additional diagnoses that have not been reported on claims - ✔✔II: uncover potential current diagnoses that have not been reported on claims III: prepare for future needs of its members IV: provider education ✔✔true or false: quality measures like star ratings and HEDIS have no correlation with the medical record info that is collected in support of risk adjustment - ✔✔false ✔✔true or false: stars ratings help identify top performing health providers - ✔✔true ✔✔commercial plans through healthcare changes use which risk adjustment model - ✔✔HHS HCC ✔✔true or false: coders are accustomed to submitting diagnosis codes on claims for the purposes of reimbursement validation for services rendered - ✔✔false ✔✔which statement is coded as a history of conditions a - history of heart transplant b - history of Alzheimers dementia c - history of prostate cancer, seed implant next week for radiation d - history of breast ca, no further treatment necessary - ✔✔d: history of breast cancer, no further treatment necessary ✔✔what is the rule regarding uncertain diagnosis for outpatient records - ✔✔conditions stated as probable, suspected, likely, questionable, possible, or still to be ruled out are not reported ✔✔which of the following providers is an acceptable provider type for RADV audits a - nutritionist b - pharmacist c - dme provider d - audiologist - ✔✔D: audiologist ✔✔true or false: to code a condition as a manifestation, the cause and effect relationship must be documented, unless the condition falls under the " with" guideline in the icd- 10 - cm - ✔✔true