AAPC-CRC Certified Risk Adjustment Coder - Set 3 - Part 3

Correct Answer: Provider incentives for query response rates

The organizational policy list covers vendor vetting, human review, audit frequency and methodology, staff training, and reporting and correcting noncompliant queries. Provider incentives tied to response rates are not among the required policy topics. Option a is incorrect because vendor vetting and compliance review of technology query tools is the first policy topic listed for organizations using technology in the query process. Option b is incorrect because policies are expected to cover audit frequency and methodology specific to technology query output, so this is a listed policy area. Option c is incorrect because training requirements for users of technology query tools appear among the listed policy topics, making this a genuine member of the set.

Correct Answer: Dietitian

Query guidance lists the dietitian as a non-provider clinician who may be asked about body mass index. Such queries cover information other than a diagnosis, and organizational guidelines or policies determine when they are permissible. Option a is incorrect because this role is named for clarification of social determinants/drivers of health, a different subject from body mass index. Option c is incorrect because this is an administrative role without direct clinical care in the encounter, so its documentation cannot serve as a query response. Option d is incorrect because this clinician is the listed query recipient for mechanical ventilation, not for body mass index, which the guidance assigns to a different role.

Correct Answer: Accepted as reportable without additional query

Query guidance states that additional diagnostic specificity or new diagnoses from other providers, such as consultants and specialists, are accepted as reportable without additional query, unless they conflict with the attending provider's documentation. Option b is incorrect because prior encounters can inform a query, but code assignment rests on current-encounter documentation, so no prior review is required first. Option c is incorrect because guidance requires attending involvement only when documentation conflicts, so confirmation is not a standing step for consultant documentation that fits the attending record. Option d is incorrect because a physician advisor holds an administrative role, and that role's documentation cannot serve as a query response for the specific encounter.

Correct Answer: Intent and pattern of the queries

Noncompliance with multiple queries is defined by intent and pattern, not by number alone. Repeating a similar query to pressure, override or circumvent a provider's clinical judgment for a preferred outcome is what makes it noncompliant. Option a is incorrect because the guidance states noncompliance is defined by intent and pattern, not by number alone, and organizations should not judge only on whether more than one query was sent. Option b is incorrect because specialty bears on whom to query, where the query goes to the provider most appropriate for the subject matter, not on whether multiple queries are compliant. Option c is incorrect because episode of care is only the span within which an organization may set policies on timing and concurrent queries; it does not define noncompliance.

Correct Answer: Plain text

The practice brief calls plain text the best practice for all query content created by the query professional. Bolded, underlined, italicized, or colored text is avoided unless it appears exactly so in the original health record documentation. Option a is incorrect because colored text is named alongside bold, underline and italics as formatting not to use in query content the query professional creates. Option b is incorrect because the brief directs query professionals not to use bolded text unless it appears exactly that way in the original health record documentation. Option d is incorrect because italics are listed among the formats to avoid in query content, with the same exception for exact reproduction of health record text.

Correct Answer: Query governance and oversight

Defining ownership of the query process, authorized roles including staff and vendors, and approval and maintenance of EHR query templates are the listed elements of query governance and oversight in a sample organizational query policy. Option a is incorrect because that category covers when a query is appropriate, required components such as clinical indicators and balanced response options, and limits on multiple queries, not role assignment. Option c is incorrect because that area concerns regular audits of templates for compliance, clarity, and clinical relevance, plus training for template creators and users, not defining authorized roles. Option d is incorrect because that category addresses the type and number of clinical indicators required to support a query, rather than who owns, approves, or answers queries.

Correct Answer: Supporting clinical accuracy and integrity

Query practice guidance states that queries are a communication tool to support clinical accuracy and integrity. They are not a mechanism to influence reimbursement, quality outcomes, or reporting metrics. Option a is incorrect because quality outcomes are named alongside reimbursement as results a query must not be used to influence; the query's role is clarification of documentation. Option b is incorrect because guidance states queries must not be used as a mechanism to influence reimbursement, so this describes an improper purpose rather than a proper one. Option c is incorrect because reporting metrics are listed among the things queries must not influence, so changing them cannot serve as the legitimate purpose of a query.

Correct Answer: A signed mental or behavioral health assessment

The regulation allows a State-licensed provider who is prohibited by State privacy laws from furnishing a complete record for mental or behavioral health treatment to furnish a signed mental or behavioral health assessment instead. Option a is incorrect because a signature log is one of the processes contractors may pursue when they have authenticity concerns about documentation, not a record the provider furnishes for validation. Option c is incorrect because a delayed entry is documentation added after a service was rendered, and the guidance says its date and author should be identifiable, so it is unrelated to the exception. Option d is incorrect because the guidance addresses scribes in connection with who signs medical record entries, and it gives no role to a scribe in the privacy-law exception.

Correct Answer: An attestation from a colleague in the same group

Reviewers shall NOT consider attestation statements from someone other than the author of the entry, even when both individuals are in the same group. One person should not sign for another in entries or attestations. Option b is incorrect because the guidance says attestations are considered regardless of creation date, unless a rule requires the signature to be in place before a given event or date. Option c is incorrect because the guidance directs reviewers to consider attestations that meet the stated requirements, and the entry's own author is the person whose attestation qualifies. Option d is incorrect because reviewers consider attestations that have an associated medical record entry, and such a link is a basic requirement for consideration.

Correct Answer: Deleting the submitted diagnosis codes as soon as possible

Plan sponsors must ensure diagnoses are documented as a result of a face-to-face visit. When an internal review finds submitted codes that do not meet requirements, the sponsor is responsible for deleting them as soon as possible. Option a is incorrect because recalculation requests are tied to final risk scores for a previous payment year, not to invalid codes found in an internal review. Option b is incorrect because physician confirmation cannot replace the face-to-face visit requirement, and the guidance directs removal of codes that fail submission requirements. Option c is incorrect because attestation belongs to Medicare contractor medical review of signature requirements and does not cure a diagnosis that lacks a face-to-face visit.