CCP HEDIS & Star Rating Measures 3 — Questions and Answers
Question 1: In Star Ratings, which type of measure is weighted at 3x compared to standard process measures?
- Outcome and intermediate outcome measures (Correct answer)
- Patient experience measures
- Access and availability measures
- Process adherence measures
Correct 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.
Question 2: A plan receives a 4-star or higher rating for three consecutive years. What financial benefit may it qualify for?
- Quality Bonus Payment (QBP) (Correct answer)
- Enhanced Benchmark Subsidy (EBS)
- Merit-Based Incentive Payment (MIPS)
- Performance Excellence Rebate (PER)
Correct 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.
Question 3: Which HEDIS measure evaluates follow-up care for members after a mental health hospitalization?
- Follow-Up After Hospitalization for Mental Illness (FUH) (Correct answer)
- Behavioral Health Readmission Rate (BHRR)
- Mental Health Continuity Index (MHCI)
- Post-Discharge Psychiatric Engagement (PDPE)
Correct 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.
Question 4: A care manager notes that a member's LDL-C result is missing despite statin therapy. Which HEDIS measure is most affected?
- Statin Adherence – LDL-C Monitoring (SAM)
- Cardiovascular Monitoring for People with Cardiovascular Conditions (CMC)
- Cholesterol Management for Patients with Cardiovascular Conditions (CMC)
- Comprehensive Diabetes Care – LDL Screening (Correct answer)
Correct 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.
Question 5: What does the term 'hybrid method' mean in HEDIS data collection?
- Using both administrative claims and medical record data to calculate a measure (Correct answer)
- Combining member survey results with clinical data
- Merging HEDIS and CAHPS reporting into one submission
- Blending Medicare and Medicaid data sources
Correct 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.
Question 6: Under the CMS Star Ratings, which survey tool specifically captures member satisfaction with drug plans?
- Part D CAHPS (Correct answer)
- HEDIS Pharmacy Experience Survey
- Medicare Consumer Satisfaction Index
- Prescription Drug Member Assessment Tool
Correct answer: Part D CAHPS
The Part D CAHPS survey measures member-reported experiences with their prescription drug plan, including customer service and drug information.
Question 7: Which HEDIS measure focuses on reducing unnecessary antibiotic prescribing for upper respiratory infections?
- Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB) (Correct answer)
- Appropriate Antibiotic Use Index (AAUI)
- Respiratory Infection Stewardship Measure (RISM)
- Upper Respiratory Prescribing Rate (URPR)
Correct 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.
CCP HEDIS & Star Rating Measures 3
In Star Ratings, which type of measure is weighted at 3x compared to standard process measures?