CDEO TEST BANK QUESTIONS WITH
VERIFIED ANSWERS FULL REVIEW
●● Suspect Logic
Answer: Many organizations utilize a method such as this one to
uncover diagnoses which are likely present but unreported or unknown
●● Chart Reviews
Answer: Analysis of the information identified is used to target
retrospective reviews to capture any unreported diagnoses
●● Suspect Logic Factors
Answer: * Known/Expected clinical progression of an illness or disease
* DME needs
* PDE
* Laboratory test findings
* CPT codes reported during the year in review
* HCPCS codes reported during the year in review
* Socioeconomic status
* Disability: Hospice: ESRD and other such statuses of the patient being
reviewed
,●● Quality of Care
Answer: Quality Measures
Star Ratings
●● HEDIS
Answer: Healthcare Effectiveness Data and Information Set
●● CMS Stars Ratings
Answer:
●● QBPs
Answer: Quality Bonus Payments
●● Quality Bonus Payments
Answer: TO make quality of care a priority the Affordable Care Act set a
requirement that CMS make quality bonus payments to Medicare
Advantage plans that earn four or more stars in a five-star quality rating
system would receive a bonus payment. Earning fewer than four stars
would receive no bonus.
●● CMS Demonstration Period
Answer: Beginning in 2012, CMS conducted a nationwide 3 year
demonstration project where by a scaled bonus program was used, with
the expectation that Medicare Advantage organizations with three or
, more stars would push themselves toward earning four and five star
ratings. During this period, plans that were at or above three stars would
receive quality bonus payments based on a sliding scale.
●● Star Ratings
Answer: the star ratings ranked plans on a calse from one to five stars, in
half-star increments defined in the following manner
* 5 STARS = EXCELLENT PERFORMANCE
* 4 STARS = ABOVE AVERAGE PERFORMANCE
* 3 STARS = AVERAGE PERFORMANCE
* 2 STARS = BELOW AVERAGE PERFORMANCE
* 1 STAR = POOR PERFORMANCE
●● Stars Ratings
Answer: are based on individual quality metrics or measures, variable
weights are given to each measure; those related to outcomes are
weighted highest, followed by patient experience measures and process
measures.
Medicare Advantage Plans as well as Prescription Drug Plans, are
equally tasked with these quality measures.
●● Medicare Advantage HMO Plan Part C: Domain 1
VERIFIED ANSWERS FULL REVIEW
●● Suspect Logic
Answer: Many organizations utilize a method such as this one to
uncover diagnoses which are likely present but unreported or unknown
●● Chart Reviews
Answer: Analysis of the information identified is used to target
retrospective reviews to capture any unreported diagnoses
●● Suspect Logic Factors
Answer: * Known/Expected clinical progression of an illness or disease
* DME needs
* PDE
* Laboratory test findings
* CPT codes reported during the year in review
* HCPCS codes reported during the year in review
* Socioeconomic status
* Disability: Hospice: ESRD and other such statuses of the patient being
reviewed
,●● Quality of Care
Answer: Quality Measures
Star Ratings
●● HEDIS
Answer: Healthcare Effectiveness Data and Information Set
●● CMS Stars Ratings
Answer:
●● QBPs
Answer: Quality Bonus Payments
●● Quality Bonus Payments
Answer: TO make quality of care a priority the Affordable Care Act set a
requirement that CMS make quality bonus payments to Medicare
Advantage plans that earn four or more stars in a five-star quality rating
system would receive a bonus payment. Earning fewer than four stars
would receive no bonus.
●● CMS Demonstration Period
Answer: Beginning in 2012, CMS conducted a nationwide 3 year
demonstration project where by a scaled bonus program was used, with
the expectation that Medicare Advantage organizations with three or
, more stars would push themselves toward earning four and five star
ratings. During this period, plans that were at or above three stars would
receive quality bonus payments based on a sliding scale.
●● Star Ratings
Answer: the star ratings ranked plans on a calse from one to five stars, in
half-star increments defined in the following manner
* 5 STARS = EXCELLENT PERFORMANCE
* 4 STARS = ABOVE AVERAGE PERFORMANCE
* 3 STARS = AVERAGE PERFORMANCE
* 2 STARS = BELOW AVERAGE PERFORMANCE
* 1 STAR = POOR PERFORMANCE
●● Stars Ratings
Answer: are based on individual quality metrics or measures, variable
weights are given to each measure; those related to outcomes are
weighted highest, followed by patient experience measures and process
measures.
Medicare Advantage Plans as well as Prescription Drug Plans, are
equally tasked with these quality measures.
●● Medicare Advantage HMO Plan Part C: Domain 1
