C4 Risk Adjustment Models

Question 1

Which risk adjustment model is typically used for Medicaid patients?

Answer 1

Chronic illness and disability payment systems CDPS

Question 2

Which is a fault statement regarding retrospective chart reviews?

Answer 2

Retrospective reviews are performed after the face-to-face visit, but before the visit is finalized.

Question 3

I’ll risk adjustment models use diagnosis codes to determine potential patient level risk. What additional elements are taken into consideration?

Answer 3

Age insurance status claim data elements socioeconomic status

Question 4

True or false? The CMS national average risk score varies each year.

Answer 4

false

Question 5

Which type of review includes a review of current year combined with the prior years dates of service?

Answer 5

Concurrent review

Question 6

Which risk adjustment model is typically used for patients enrolled in a commercial plan through a healthcare exchange?

Answer 6

Health and human services hierarchal condition category

Question 7

Which risk adjustment model is used for patients enrolled in a Medicare advantage plan?

Answer 7

Medicare hierarchal condition category CMSHCC