CMS Quality Assurance & Standards 2 — Questions and Answers
Question 1: Which CMS program uses star ratings to evaluate Medicare Advantage and Part D plan quality?
- Hospital Compare
- Five-Star Quality Rating System (Correct answer)
- Quality Payment Program
- Value-Based Insurance Design
Correct answer: Five-Star Quality Rating System
The Five-Star Quality Rating System rates Medicare Advantage and Part D plans on a scale of 1 to 5 stars based on quality and performance measures.
Question 2: What is the minimum star rating a Medicare Advantage plan must generally maintain to avoid sanctions under CMS quality standards?
- 2 stars
- 2.5 stars (Correct answer)
- 3 stars
- 3.5 stars
Correct answer: 2.5 stars
Plans that receive less than 2.5 stars for three consecutive years may face low-performing plan designations and enrollment restrictions.
Question 3: HEDIS measures used in Medicare quality reporting are developed and maintained by which organization?
- CMS
- NCQA (Correct answer)
- The Joint Commission
- URAC
Correct answer: NCQA
The National Committee for Quality Assurance (NCQA) develops and maintains HEDIS (Healthcare Effectiveness Data and Information Set) measures.
Question 4: Under the Medicare Quality Payment Program, what does MIPS stand for?
- Medicare Incentive Payment System
- Merit-based Incentive Payment System (Correct answer)
- Managed Incentive Performance Standards
- Medicare Integrated Performance Scoring
Correct answer: Merit-based Incentive Payment System
MIPS (Merit-based Incentive Payment System) is a track within the Quality Payment Program that adjusts clinician payments based on performance scores.
Question 5: Which measure category carries the most weight in MIPS scoring under the Quality Payment Program?
- Promoting Interoperability
- Improvement Activities
- Quality (Correct answer)
- Cost
Correct answer: Quality
The Quality category historically carries the highest weight (30%) in MIPS composite performance scoring, though weights can change annually.
Question 6: A Medicare Advantage plan receives a 5-star rating. Which special enrollment period does this unlock for beneficiaries?
- Annual Enrollment Period
- Special Enrollment Period to switch any time during the year (Correct answer)
- Open Enrollment Period
- Initial Coverage Election Period
Correct answer: Special Enrollment Period to switch any time during the year
Beneficiaries may enroll in a 5-star rated Medicare Advantage or Part D plan at any time during the year using a special enrollment period.
Question 7: Which CMS initiative requires hospitals to publicly report quality measures and links payment to performance?
- Hospital Readmissions Reduction Program
- Hospital Value-Based Purchasing Program (Correct answer)
- Bundled Payments for Care Improvement
- Comprehensive Care for Joint Replacement
Correct answer: Hospital Value-Based Purchasing Program
The Hospital Value-Based Purchasing (VBP) Program adjusts Medicare payments to hospitals based on quality performance across multiple domains.
CMS Quality Assurance & Standards 2
Which CMS program uses star ratings to evaluate Medicare Advantage and Part D plan quality?