Quality of Care Measures Flashcards
6 cards from real CRC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Quality of Care Measures flashcards as text
How does accurate risk adjustment coding impact a Medicare Advantage plan's Star Rating?
Answer: Accurate coding ensures quality measure denominator populations are correctly identified
Accurate coding ensures patients are correctly identified for quality measure populations. Without it, quality performance appears artificially inflated.
How does risk adjustment data quality affect the HEDIS Controlling High Blood Pressure measure?
Answer: Accurate hypertension coding ensures all hypertensive members are in the denominator
HEDIS CBP requires identifying all members with hypertension. If hypertension is uncoded for some members, the denominator is incomplete.
What is the relationship between RAPS and EDS for risk adjustment?
Answer: RAPS submits diagnosis codes only; EDS submits complete encounter data for both risk adjustment and quality measurement
RAPS is diagnosis-only for risk adjustment. EDS submits complete encounter records supporting both risk adjustment and quality measurement.
How can risk adjustment coding data support a heart failure readmission reduction initiative?
Answer: By identifying all HF members, their complication profiles, and risk stratification for targeted care management
Accurate coding creates a comprehensive dataset enabling risk stratification and targeted interventions.
A plan's RAF scores increase year-over-year but health outcomes remain unchanged. What quality concern does this raise?
Answer: The pattern suggests coding intensity increases without corresponding clinical complexity changes
Rising scores without utilization/outcome changes suggests coding practice changes rather than true population health changes.
Which HEDIS measure most directly depends on accurate mental health coding?
Answer: Follow-Up After Hospitalization for Mental Illness (FUH)
FUH requires identifying members hospitalized with a principal mental health diagnosis. Accurate coding determines whether the measure is triggered.