CPMSM Practice Tests QUESTIONS AND ANSWERS RATED A+ 2023|2024 UPDATE

CPMSM Practice Tests QUESTIONS AND ANSWERS RATED A+ 2023|2024 UPDATE What does HEDIS stand for? - Correct Answer-Healthcare Effectiveness Data and Information Set What is HEDIS? - Correct Answer-is a widely used set of performance measures in the managed care industry. HEDIS is a multipurpose tool originally designed to address private employers' needs and has been adopted by public purchasers, regulators and consumers. HEDIS is an element of NCQA accreditation and the basis of consumer report cards for managed care. HEDIS data is collected through a combination of surveys, provider medical record audits and insurance claims data. Why is it important for healthcare and staff members to become familiar with HEDIS? - Correct Answer-To understand what health plans are required to report in order to improve the quality of patient care HEDIS reporting is required by who? - Correct Answer-NCQA & CMS Where is data collected for HEDIS? - Correct Answer-Data collection begins with queries of the claims or encounter data. If claims data does not include evidence that a service was provided within the required time frame, then the health plan must review the medical record to determine if care was provided. For some measures, data is only collected from claims.