CCP HEDIS & Star Rating Measures 3

Question 1

In Star Ratings, which type of measure is weighted at 3x compared to standard process measures?

Accepted Answer

Outcome and intermediate outcome measures

Answer

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?

Accepted Answer

Quality Bonus Payment (QBP)

Answer

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?

Accepted Answer

Follow-Up After Hospitalization for Mental Illness (FUH)

Answer

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?

Accepted Answer

Comprehensive Diabetes Care – LDL Screening

Answer

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?

Accepted Answer

Using both administrative claims and medical record data to calculate a measure

Answer

The hybrid method allows plans to supplement administrative claims data with medical record review to improve HEDIS measure rates.

(CCP) Chronic Care Professional Certification Practice Test

(CCP) Chronic Care Professional Certification Practice Test

CCP HEDIS & Star Rating Measures 3