CMS Quality Assurance & Standards 4

Question 1

Which CMS program specifically targets reducing healthcare-associated infections (HAIs) in acute care hospitals?

Accepted Answer

Hospital Acquired Condition Reduction Program

Answer

The Hospital Acquired Condition (HAC) Reduction Program penalizes hospitals in the worst-performing quartile for rates of hospital-acquired conditions including infections.

Question 2

What is the purpose of the Medicare Advantage Improvement Measures (IMs) in the Five-Star Quality Rating System?

Accepted Answer

To reward plans showing improvement even if they haven't reached high absolute scores

Answer

Improvement Measures reward plans that demonstrate significant year-over-year improvement in quality, incentivizing progress even among lower-performing plans.

Question 3

A Part D plan sponsor is required to have a medication therapy management (MTM) program. Which beneficiaries must be targeted for enrollment?

Accepted Answer

Enrollees with multiple chronic conditions, multiple Part D drugs, and likely to incur high drug costs

Answer

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.

Question 4

Which quality measure domain in the Five-Star Rating System is most closely tied to HEDIS clinical data?

Accepted Answer

Managing Chronic and Acute Conditions

Answer

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.

Question 5

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?

Accepted Answer

Nominal financial risk based on CMS benchmarks

Answer

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) Certified Medicare Specialist Practice Test

(CMS) Certified Medicare Specialist Practice Test

CMS Quality Assurance & Standards 4