CMS Quality Assurance & Standards 3

Question 1

What does the Hospital Readmissions Reduction Program (HRRP) penalize hospitals for?

Accepted Answer

Excessive readmissions within 30 days for certain conditions

Answer

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.

Question 2

Which CMS quality framework uses the domains of Safe, Timely, Effective, Efficient, Equitable, and Patient-centered?

Accepted Answer

IOM Six Aims

Answer

The Institute of Medicine (IOM) identified six aims for quality improvement—Safe, Timely, Effective, Efficient, Equitable, and Patient-centered—in 'Crossing the Quality Chasm.'

Question 3

Under CMS regulations, Medicare Advantage organizations must have a Quality Improvement Program that includes which required element?

Accepted Answer

Chronic care improvement programs (CCIPs)

Answer

MA organizations are required to operate Chronic Care Improvement Programs (CCIPs) targeting enrollees with multiple chronic conditions as part of their Quality Improvement Program.

Question 4

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey measures which aspect of Medicare plan quality?

Accepted Answer

Member experience and satisfaction

Answer

CAHPS surveys capture enrollee-reported experiences with their health plan and providers, contributing to star ratings under the Five-Star system.

Question 5

A Medicare Advantage plan is flagged as a 'low-performing plan.' What must CMS do under this designation?

Accepted Answer

Display a low-performing icon on Medicare Plan Finder

Answer

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.

(CMS) Certified Medicare Specialist Practice Test

(CMS) Certified Medicare Specialist Practice Test

CMS Quality Assurance & Standards 3