HEDIS & Star Rating Measures Flashcards
7 cards from real CCP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 HEDIS & Star Rating Measures flashcards as text
In Star Ratings, which type of measure is weighted at 3x compared to standard process measures?
Answer: Outcome and intermediate outcome measures
CMS assigns a 3x weight multiplier to outcome and intermediate outcome measures to emphasize results-driven quality improvement in Star Ratings.
A plan receives a 4-star or higher rating for three consecutive years. What financial benefit may it qualify for?
Answer: Quality Bonus Payment (QBP)
Medicare Advantage plans achieving 4 or more stars for three consecutive years qualify for Quality Bonus Payments, which increase their benchmark payments from CMS.
Which HEDIS measure evaluates follow-up care for members after a mental health hospitalization?
Answer: Follow-Up After Hospitalization for Mental Illness (FUH)
The FUH measure tracks the percentage of discharges followed by outpatient mental health follow-up within 7 and 30 days.
A care manager notes that a member's LDL-C result is missing despite statin therapy. Which HEDIS measure is most affected?
Answer: Comprehensive Diabetes Care – LDL Screening
The Comprehensive Diabetes Care measure includes an LDL-C screening component, making missing LDL results a gap in HEDIS performance for diabetic members.
What does the term 'hybrid method' mean in HEDIS data collection?
Answer: Using both administrative claims and medical record data to calculate a measure
The hybrid method allows plans to supplement administrative claims data with medical record review to improve HEDIS measure rates.
Under the CMS Star Ratings, which survey tool specifically captures member satisfaction with drug plans?
Answer: Part D CAHPS
The Part D CAHPS survey measures member-reported experiences with their prescription drug plan, including customer service and drug information.
Which HEDIS measure focuses on reducing unnecessary antibiotic prescribing for upper respiratory infections?
Answer: Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB)
The AAB measure tracks the percentage of adults with acute bronchitis who were NOT prescribed antibiotics, rewarding appropriate stewardship.