What is the function of Risk Adjustment? 2. How many principles were used to develop the risk adjustment model? 3. Which principle encourages specificity of ICD-10-CM coding? 4. Risk Adjust
HCC coding
Please note, CMS publishes updated Risk Adjustment models on an annual basis. For this assignment, the year 2020 is being used to address the questions.
Use the following URL for questions 1-10: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/RTC-DEC2018.pdf
1. What is the function of Risk Adjustment?
2. How many principles were used to develop the risk adjustment model?
3. Which principle encourages specificity of ICD-10-CM coding?
4. Risk Adjustment only utilizes ICD-10-CM to determine HCC categories?
5. What is the purpose of assigning a hierarchy when coding for HCCs
6. The CMS-HCC V23 model includes 79 HCCs.
7. Every diagnoses that is billed for a Medicare Advantage beneficiary computes into an HCC?
8. Medicare Advantage beneficiaries that also have Medicaid are considered a dual per Risk Adjustment.
9. How many CMS-HCC community models are based on age/disabled status and dual status?
10. A separate CMS-HCC model exists for End Stage Renal Disease (ESRD) Medicare Advantage beneficiaries.
Use the following URL for questions 11-15: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Risk-Adjustors-Items/Risk2020
Click on the 2020 Model Software/ICD-10 Mappings and then download the 2020 Midyear Final ICD-10 Mappings(ZIP). Open the second file type: Microsoft Excel Worksheet
11. On the 2020 Midyear_Final ICD-10-CM Mappings Excel file, diagnosis code A36.84 is included on the CMS-HCC Model Category V24?
12. Diagnosis code L40.0 is listed on the CMS-HCC Model Categories V21-V24.
13. What is the CMS-HCC Model Category V24 does T55.0X2A fall under?
14. What is the RxHCC Model Category V05 for diagnosis code Z94.81?
15. Diagnosis M84.40X1 is a RxHCC?
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