HCQM HIGH YIELD NOTES
2026/2027 ACTUAL QUESTIONS
WITH VERIFIED ANSWERS.
AKS(Anti kickback law)- - correct answer-is criminal and civil
refers to anyone. "Kicking is a felony"
Capitated Payment - correct answer-capitated payment ;the
entity providing care is at full risk for any services required by
the enrollee.
4 techniques of utilization management - correct answer-•
Demand Management
• Utilization Review
• Case Management
• Disease Management
Medicare Part A - correct answer-Hospital
SNF (A only if it follows within 30 days of a hospitalization of
three or more days and is certified as medically necessary. 100
days per policy period)
, MEDICAID - correct answer-In 2023 these limits are: $14,580
for a single adult person, $30,000 for a family of four and
$50,560 for a family of eight
Can cover long term nuring beyond medicare's 100 days if
income <1677, blind, >65
Accountable Care Organization (ACO) - correct answer-An
association of providers and third-party payers that assumes a
defined range of responsibilities for a specific population and is
held accountable, financially as well as through specific quality
indicators, for its members' health
MIPS (Merit-Based Incentive Payment System) - correct
answer-CMS Program for incentive that combines physician
quality reporting system (PRRS) & Medicare EHRs based on
QUALITY, resource use, clinical practice environment &
meaningful use of EHR tech.
*quality, cost, improvement activities, and Promoting
Interoperability
2026/2027 ACTUAL QUESTIONS
WITH VERIFIED ANSWERS.
AKS(Anti kickback law)- - correct answer-is criminal and civil
refers to anyone. "Kicking is a felony"
Capitated Payment - correct answer-capitated payment ;the
entity providing care is at full risk for any services required by
the enrollee.
4 techniques of utilization management - correct answer-•
Demand Management
• Utilization Review
• Case Management
• Disease Management
Medicare Part A - correct answer-Hospital
SNF (A only if it follows within 30 days of a hospitalization of
three or more days and is certified as medically necessary. 100
days per policy period)
, MEDICAID - correct answer-In 2023 these limits are: $14,580
for a single adult person, $30,000 for a family of four and
$50,560 for a family of eight
Can cover long term nuring beyond medicare's 100 days if
income <1677, blind, >65
Accountable Care Organization (ACO) - correct answer-An
association of providers and third-party payers that assumes a
defined range of responsibilities for a specific population and is
held accountable, financially as well as through specific quality
indicators, for its members' health
MIPS (Merit-Based Incentive Payment System) - correct
answer-CMS Program for incentive that combines physician
quality reporting system (PRRS) & Medicare EHRs based on
QUALITY, resource use, clinical practice environment &
meaningful use of EHR tech.
*quality, cost, improvement activities, and Promoting
Interoperability
