CMS Quality Assurance & Standards 2

Question 1

Which CMS program uses star ratings to evaluate Medicare Advantage and Part D plan quality?

Accepted Answer

Five-Star Quality Rating System

Answer

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?

Accepted Answer

2.5 stars

Answer

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?

Accepted Answer

NCQA

Answer

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?

Accepted Answer

Merit-based Incentive Payment System

Answer

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?

Accepted Answer

Quality

Answer

The Quality category historically carries the highest weight (30%) in MIPS composite performance scoring, though weights can change annually.

(CMS) Certified Medicare Specialist Practice Test

(CMS) Certified Medicare Specialist Practice Test

CMS Quality Assurance & Standards 2