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
A member with diabetes has documented nephropathy. How does this affect the HEDIS Comprehensive Diabetes Care (CDC) measure for urine protein screening?
Answer: The member is excluded from the urine protein testing component as already diagnosed
Members with existing nephropathy are excluded from the urine protein testing sub-measure because monitoring for nephropathy is no longer needed when it has already been diagnosed.
Which HEDIS measure evaluates whether members on long-term opioid therapy received a urine drug screen?
Answer: Opioid Management Monitoring – Urine Screening (OMM)
The OMM measure assesses whether members receiving chronic opioid therapy had a urine drug screen performed, supporting safe prescribing practices.
Under CMS Star Ratings, which of the following is an example of an 'intermediate outcome' measure?
Answer: HbA1c control in diabetic members
HbA1c control is an intermediate outcome because it reflects a measurable biological marker that links care processes to ultimate health outcomes like hospitalizations.
What is the significance of the 'low-income subsidy (LIS) indicator' in CMS Star Ratings calculations?
Answer: CMS adjusts certain patient experience and access measures for plans with high LIS populations to account for social risk factors
CMS applies a reward factor for plans serving a high proportion of LIS beneficiaries on specific measures, recognizing the added challenge of caring for socially at-risk populations.
A care manager wants to improve the Annual Monitoring for Patients on Persistent Medications (MPM) HEDIS measure. Which action is MOST appropriate?
Answer: Identify members on ACE inhibitors or diuretics who lack documentation of required lab tests
The MPM measure requires annual lab monitoring for members on specific persistent medications; closing gaps means identifying those lacking required labs and facilitating testing.
What does a 'cut point' represent in the CMS Star Ratings framework?
Answer: The threshold performance score that separates one star level from the next
Cut points are the performance thresholds CMS sets to determine star assignments; a plan's measure rate must exceed a cut point to achieve a higher star level on that measure.
Which HEDIS measure assesses the appropriateness of imaging for low back pain in primary care?
Answer: Use of Imaging Studies for Low Back Pain (LBP)
The LBP HEDIS measure calculates the percentage of members with a primary diagnosis of low back pain who did NOT receive imaging within 28 days of the diagnosis, rewarding appropriate conservative management.