Risk Adjustment
RADV
What is Risk Adjustment Data Validation?
Publisher of ICD-10
What is the World Health Organization (WHO)?
"with"
What is the word that now demonstrates an assumed causal relationship between conditions in both the Index and the Tabular of ICD-10-CM?
H.E.D.I.S.
What is Healthcare Effectiveness Data & Information Set?
F
What is the character at the end of all CPT Category II codes?
CAHPS
What is Consumer Assessment of Healthcare Providers and Systems. CAHPS is an annual survey that asks consumers to evaluate their experiences with health care services.
115
How many HCCs are in the 2024 CMS-HCC model?
3 to 7
How many characters are there in an ICD-10-CM code?
ADDC
What is accurate documentation and diagnostic coding?
True or False: CBP numerators can be closed with CPT Category II codes.
What is True?
True or False: All HEDIS measures allow for CPT Category II reporting to close numerators.
What is False?
HOS
What is Health Outcomes Survey? HOS uses patient-reported health outcomes to assess how well Medicare Advantage Health Plans (Part C only) maintain or improve the physical and mental health of members over time.
67%/33%
What is the 2024 PY MA RA model blend?
a commonly used code that is also the name of the code set
What is I10?
Code all conditions _______ and any condition that _______ _________.
What are "treated" and "affects treatment?"
the place you would find the content of each HEDIS measure
What are the HEDIS Technical Specifications or Tech Specs?
.01
What is the value that is put on the CPT Category II code so that it will populate on a claim?
38%
What percentage of the total Star Rating is based on CAHPS survey results?
This identifies the health status of each patient and allocates resources for care.
What is the Risk Adjustment Factor (RAF) score?
the place where you find specific coding guidance for each chapter
What are the ICD-10-CM Official Guidelines for Coding and Reporting?
Per the ICD-10-CM Official Guidelines for Coding and Reporting, Guideline I.B.18., "Each healthcare encounter should be coded to the level of certainty _______ for that encounter."
What is known?
VSD
What is the Value Set Data or the place where you would find the codes for the denominators, the numerators and the exclusions for the HEDIS measures?
HBD & EED have this requirement in common
What CPT II codes require the date of the test, not the date of the office visit when the test was reviewed?
Participation in survey is _________.
What is voluntary? The surveys are administered to a random sample of members from each contract and participation is voluntary.
CMS-HCC
What is the abbreviation for the Medicare Advantage risk adjustment model (Centers for Medicare & Medicaid Services Hierarchical Condition Category)?
SDOH
What are Social Determinants of Health? What are the codes that describe conditions/circumstances that affect health equity?
M.E.A.T.
What is Monitor, Evaluate, Assess/Address or Treat?
Frailty and Advanced Illness
What are two exclusions that exclude patients from certain HEDIS measures?
1P, 2P, 3P, 8P
What are the CPT Category II modifiers? They do not exclude the patient from the denominator nor do they close the numerator. They exclude the code from HEDIS reporting.
Surveys are administered by _______.
What are vendors? The surveys are administered by vendors certified by the National Committee for Quality Assurance(NCQA) and the Centers of Medicare and Medicaid Services (CMS).