AI in HCC Risk Adjustment Coding Quiz

Answers and explanations appear as you take the quiz.

1. What happens under CMS-HCC hierarchies when related conditions of different severity are both coded?
   • Both categories are paid and added together
   • Only the most severe category in that family counts
   • The least severe category counts
   • Neither counts until the next year
2. Why must a chronic condition be documented again each calendar year?
   • ICD-10-CM codes expire every year
   • Plans are paid only for new conditions
   • Diagnoses reset annually in the risk model
   • HIPAA requires it
3. Notes mention dialysis, but no provider has documented ESRD. What does the correct workflow do?
   • Sends a documentation query rather than coding ESRD
   • Codes ESRD because dialysis implies it
   • Codes ESRD if the AI's confidence is above 90 percent
   • Deletes all kidney-related codes
4. What makes a chart review "two-way"?
   • Two coders review every chart
   • The plan and CMS each review the chart
   • The chart is read forward and backward
   • It looks for missed codes and also flags unsupported submitted codes for deletion
5. Which statement about MEAT is accurate according to the guide?
   • It is a CMS regulation with fixed penalties
   • It is an industry audit convention; the requirement is documentation that supports the code
   • It applies only to inpatient claims
   • It was replaced by V28
6. An office visit uses an acute stroke code for a stroke that happened years ago. What should a two-way review recommend?
   • Keep it, since acute codes pay more
   • Add a second acute stroke code
   • Delete it and use a code for stroke history or its lasting effects, as documented
   • Move it to the next year's submission
7. Which source does NOT qualify for HCC submission?
   • A diagnostic radiology report
   • A face-to-face office visit with a physician
   • A qualifying outpatient visit with a nurse practitioner
   • A hospital inpatient stay
8. What pipeline step catches most false positives in AI chart review?
   • OCR of scanned pages
   • Calculating the RAF score
   • Sorting charts by date
   • Context detection for negated, historical or family-history mentions