Certified Risk Adjustment Coder (CRC)

What information is reported by a provider for beneficiaries in a Medicare Advantage Plan?

1. Family history for all conditions

2. Resolved conditions treated in the past

3. All chronic conditions

4. All of the above

The correct answer is: All of the above

The correct choice indicates that all the listed information—family history for all conditions, resolved conditions treated in the past, and all chronic conditions—should be reported by a provider for beneficiaries in a Medicare Advantage Plan. Medicare Advantage Plans require comprehensive data to ensure appropriate risk adjustment, which helps determine the funding the plans receive based on the health status of their members. Including family history is essential as it can indicate the likelihood of future conditions, thus assisting in better risk management. Resolved conditions are also relevant since they may impact current treatment plans, healthcare needs, and future risks. Reporting all chronic conditions is crucial for accurate risk assessment and reimbursement purposes, as chronic illnesses are often more resource-intensive and can lead to higher healthcare costs over time. Incorporating all these elements provides a more complete and accurate picture of a beneficiary's health, which in turn supports the quality of care and management within the Medicare Advantage framework.