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CDEO Chapter 8 Questions with Correct Answers
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CDEO Chapter 8 Questions with Correct Answers
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CDEO Chapter 8 Questions with Correct AnswersPREDICTIVE MODELING Correct Answer-is an analytical review of
known data elements to establish a hypothesis related to the future health
needs of patients or a population of patients
Suspect Logic Correct Answer-Many organizations utilize a method
such as this one to uncover diagnoses which are likely present but
unreported or unknown
Chart Reviews Correct Answer-Analysis of the information identified is
used to target retrospective reviews to capture any unreported diagnoses
Suspect Logic Factors Correct Answer-* Known/Expected clinical
progression of an illness or disease
* DME needs
* PDE
* Laboratory test findings
* CPT codes reported during the year in review
* HCPCS codes reported during the year in review
* Socioeconomic status
* Disability: Hospice: ESRD and other such statuses of the patient being
reviewed
Quality of Care Correct Answer-Quality Measures
Star Ratings
,HEDIS Correct Answer-Healthcare Effectiveness Data and Information
Set
CMS Stars Ratings Correct Answer-
QBPs Correct Answer-Quality Bonus Payments
Quality Bonus Payments Correct Answer-TO make quality of care a
priority the Affordable Care Act set a requirement that CMS make
quality bonus payments to Medicare Advantage plans that earn four or
more stars in a five-star quality rating system would receive a bonus
payment. Earning fewer than four stars would receive no bonus.
CMS Demonstration Period Correct Answer-Beginning in 2012, CMS
conducted a nationwide 3 year demonstration project where by a scaled
bonus program was used, with the expectation that Medicare Advantage
organizations with three or more stars would push themselves toward
earning four and five star ratings. During this period, plans that were at
or above three stars would receive quality bonus payments based on a
sliding scale.
Star Ratings Correct Answer-the star ratings ranked plans on a calse
from one to five stars, in half-star increments defined in the following
manner
* 5 STARS = EXCELLENT PERFORMANCE
, * 4 STARS = ABOVE AVERAGE PERFORMANCE
* 3 STARS = AVERAGE PERFORMANCE
* 2 STARS = BELOW AVERAGE PERFORMANCE
* 1 STAR = POOR PERFORMANCE
Stars Ratings Correct Answer-are based on individual quality metrics or
measures, variable weights are given to each measure; those related to
outcomes are weighted highest, followed by patient experience measures
and process measures.
Medicare Advantage Plans as well as Prescription Drug Plans, are
equally tasked with these quality measures.
Medicare Advantage HMO Plan Part C: Domain 1 Correct Answer-
Domain 1: Staying Healthy- Screenings, Test, and Vaccines (7
Measures)
Breast Cancer Screening
Colorectal Cancer Screeening
Annual Flu Vaccine
Improving or Maintaining Physical Health
Improving or Maintaining Mental Health
Monitoring Physical Activity
Adult BMI Assessment
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