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
Which CMS program specifically targets reducing healthcare-associated infections (HAIs) in acute care hospitals?
Answer: Hospital Acquired Condition Reduction Program
The Hospital Acquired Condition (HAC) Reduction Program penalizes hospitals in the worst-performing quartile for rates of hospital-acquired conditions including infections.
What is the purpose of the Medicare Advantage Improvement Measures (IMs) in the Five-Star Quality Rating System?
Answer: To reward plans showing improvement even if they haven't reached high absolute scores
Improvement Measures reward plans that demonstrate significant year-over-year improvement in quality, incentivizing progress even among lower-performing plans.
A Part D plan sponsor is required to have a medication therapy management (MTM) program. Which beneficiaries must be targeted for enrollment?
Answer: Enrollees with multiple chronic conditions, multiple Part D drugs, and likely to incur high drug costs
MTM programs must target enrollees who have multiple chronic conditions, are taking multiple Part D covered drugs, and are likely to incur drug costs above a CMS threshold.
Which quality measure domain in the Five-Star Rating System is most closely tied to HEDIS clinical data?
Answer: Managing Chronic and Acute Conditions
The Managing Chronic and Acute Conditions domain relies heavily on HEDIS measures assessing how well plans manage conditions such as diabetes, cardiovascular disease, and respiratory illness.
Under the Quality Payment Program's Alternative Payment Model (APM) track, what financial risk requirement must an APM meet to qualify as an Advanced APM?
Answer: Nominal financial risk based on CMS benchmarks
Advanced APMs must require participants to bear more than nominal financial risk (as defined by CMS thresholds) to qualify for the 5% lump-sum bonus and exclusion from MIPS.
CMS requires Medicare Advantage plans to conduct annual Health Risk Assessments (HRAs) primarily to support which function?
Answer: Accurate risk adjustment and care coordination
Annual HRAs help MA plans identify enrollee health conditions for accurate risk adjustment submissions and to develop appropriate individualized care plans.
A Medicare Advantage plan fails to meet the Part C reporting requirements on time. Which consequence can CMS impose?
Answer: Civil money penalties, suspension of enrollment, or contract termination
CMS may impose civil money penalties, suspend enrollment and marketing, or terminate the contract when a plan fails to meet Part C reporting or other compliance requirements.