Quality Assurance & Compliance Flashcards
7 cards from real ACA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Quality Assurance & Compliance flashcards as text
Which ACA provision established the National Strategy for Quality Improvement in Health Care?
Answer: Section 3011
ACA Section 3011 required HHS to develop and publish a National Quality Strategy to guide quality improvement across the health care system.
A health plan's Medical Loss Ratio (MLR) report must be submitted to CMS by what deadline each year?
Answer: June 1 following the end of the calendar year
Issuers must submit annual MLR reports to CMS by June 1 following the end of the MLR reporting year.
Under the ACA's quality reporting framework, what is a 'Consumer Assessment of Healthcare Providers and Systems' (CAHPS) survey used to measure?
Answer: Patient experience with their health plan and care
CAHPS surveys measure patients' perceptions of their experiences with health plans, providers, and facilities as part of ACA quality reporting.
Which ACA program financially penalizes hospitals with excess readmissions within 30 days of discharge?
Answer: Hospital Readmissions Reduction Program (HRRP)
The HRRP reduces Medicare payments to hospitals with higher-than-expected 30-day readmission rates for specified conditions.
Under ACA quality compliance standards, what is the primary purpose of HEDIS (Healthcare Effectiveness Data and Information Set)?
Answer: To measure health plan performance on dimensions of care and service
HEDIS is a widely used tool that allows consumers to compare health plan performance across standardized quality and service measures.
When a QHP issuer fails to meet ACA MLR requirements, what must they do?
Answer: Provide rebates to enrollees, employers, or both
Issuers who fail to meet MLR thresholds must issue rebates to policyholders or employers based on the excess amount spent on administrative costs.
Which document must QHP issuers provide to enrollees that summarizes the key features of their health plan in plain language?
Answer: Summary of Benefits and Coverage (SBC)
The ACA requires issuers to provide a standardized SBC that clearly explains coverage, cost-sharing, and coverage limitations in plain language.