Quality Assurance & Standards Flashcards
7 cards from real CMS 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 & Standards flashcards as text
What does the Hospital Readmissions Reduction Program (HRRP) penalize hospitals for?
Answer: Excessive readmissions within 30 days for certain conditions
The HRRP reduces Medicare payments to hospitals with higher-than-expected 30-day readmission rates for conditions such as heart attack, heart failure, and pneumonia.
Which CMS quality framework uses the domains of Safe, Timely, Effective, Efficient, Equitable, and Patient-centered?
Answer: IOM Six Aims
The Institute of Medicine (IOM) identified six aims for quality improvement—Safe, Timely, Effective, Efficient, Equitable, and Patient-centered—in 'Crossing the Quality Chasm.'
Under CMS regulations, Medicare Advantage organizations must have a Quality Improvement Program that includes which required element?
Answer: Chronic care improvement programs (CCIPs)
MA organizations are required to operate Chronic Care Improvement Programs (CCIPs) targeting enrollees with multiple chronic conditions as part of their Quality Improvement Program.
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey measures which aspect of Medicare plan quality?
Answer: Member experience and satisfaction
CAHPS surveys capture enrollee-reported experiences with their health plan and providers, contributing to star ratings under the Five-Star system.
A Medicare Advantage plan is flagged as a 'low-performing plan.' What must CMS do under this designation?
Answer: Display a low-performing icon on Medicare Plan Finder
CMS must display a low-performing plan icon on Medicare Plan Finder for plans rated below 2.5 stars for three consecutive years to alert beneficiaries.
Which reporting mechanism do Medicare Advantage plans use to submit encounter data to CMS for risk adjustment and quality purposes?
Answer: RAPS and EDPS
MA plans submit encounter data through RAPS (Risk Adjustment Processing System) and EDPS (Encounter Data Processing System) for risk adjustment and quality oversight.
Under the CMS Conditions of Participation, which entity has primary authority to investigate quality-of-care complaints in Medicare-certified facilities?
Answer: State Survey Agencies
State Survey Agencies conduct inspections and investigate complaints at Medicare-certified facilities on behalf of CMS under the Conditions of Participation.