Quality Improvement Flashcards

A QI review finds members who enrolled in Medicare at 66 kept contributing to their HSA. What risk does this create?

Answer: Excess contributions, since Medicare Part A can be retroactive up to 6 months

Retroactive Part A coverage of up to 6 months can make contributions in that window ineligible, so members should stop contributing about 6 months before enrolling.

Which metric best captures member experience in an HSA call center improvement project?

Answer: First-contact resolution rate

First-contact resolution measures whether members get their issues resolved without having to call again.

An employer contributes to HSAs outside a cafeteria plan, and an audit finds unequal contributions among comparable employees. What penalty could the employer face?

Answer: A 35% excise tax on aggregate employer HSA contributions

Failing the comparability rules for HSA contributions made outside a cafeteria plan triggers a 35% excise tax on the employer's total contributions.

During the 'Act' phase of PDCA, a successful pilot of electronic receipt uploads should be:

Answer: Standardized and rolled out across all accounts

'Act' standardizes a successful change, or adjusts it and runs the cycle again.

A process map shows HSA rollover requests passing through four approval handoffs that add no value. Which Lean waste is this?

Answer: Overprocessing/unnecessary motion

Extra approval steps that add no value to the member are overprocessing waste in Lean.

An audit finds members doing multiple indirect (60-day) HSA rollovers in one year. What control should the trustee add?

Answer: Limit indirect rollovers to one per 12-month period, while allowing unlimited direct trustee-to-trustee transfers

Only one 60-day HSA rollover is allowed per 12 months; direct trustee-to-trustee transfers have no limit.

After a fix, an HSA team keeps tracking error rates monthly to make sure gains last. Which DMAIC phase is this?

Answer: Control

The Control phase monitors the improved process so performance holds over time.