CDEO CHAPTER 8 LATEST EXAM 2024 WITH
100% CORRECT SOLUTIONS| BEST GRADES
GURANTEED.
1. PREDICTIVE MODELING ---ANSWERS___ is an analytical review
of known data elements to establish a hypothesis related to the
future health needs of patients or a population of patients
2. Suspect Logic ---ANSWERS___ Many organizations utilize a
method such as this one to uncover diagnoses which are likely
present but unreported or unknown
3. Chart Reviews ---ANSWERS___ Analysis of the information
identified is used to target retrospective reviews to capture any
unreported diagnoses
4. Suspect Logic Factors ---ANSWERS___ * 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
CDEO CHAPTER 8 LATEST EXAM 2024 WITH 100% CORRECT SOLUTIONS BEST GRADES GURANTEED
, 5. Quality of Care ---ANSWERS___ Quality Measures
Star Ratings
6. HEDIS ---ANSWERS___ Healthcare Effectiveness Data and
Information Set
7. CMS Stars Ratings ---ANSWERS___
8. QBPs ---ANSWERS___ Quality Bonus Payments
9. Quality Bonus Payments ---ANSWERS___ 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.
10. CMS Demonstration Period ---ANSWERS___ 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.
CDEO CHAPTER 8 LATEST EXAM 2024 WITH 100% CORRECT SOLUTIONS BEST GRADES GURANTEED
, 11. Star Ratings ---ANSWERS___ 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
12. Stars Ratings ---ANSWERS___ 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.
13. Medicare Advantage Plans as well as Prescription Drug
Plans, are equally tasked with these quality measures.
14. Medicare Advantage HMO Plan Part C: Domain 1 --
ANSWERS___ Domain 1: Staying Healthy- Screenings, Test, and
Vaccines (7 Measures)
• Breast Cancer Screening
• Colorectal Cancer Screeening
• Annual Flu Vaccine
• Improving or Maintaining Physical Health
• Improving or Maintaining Mental Health
• Monitoring Physical Activity Adult BMI Assessment
CDEO CHAPTER 8 LATEST EXAM 2024 WITH 100% CORRECT SOLUTIONS BEST GRADES GURANTEED
100% CORRECT SOLUTIONS| BEST GRADES
GURANTEED.
1. PREDICTIVE MODELING ---ANSWERS___ is an analytical review
of known data elements to establish a hypothesis related to the
future health needs of patients or a population of patients
2. Suspect Logic ---ANSWERS___ Many organizations utilize a
method such as this one to uncover diagnoses which are likely
present but unreported or unknown
3. Chart Reviews ---ANSWERS___ Analysis of the information
identified is used to target retrospective reviews to capture any
unreported diagnoses
4. Suspect Logic Factors ---ANSWERS___ * 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
CDEO CHAPTER 8 LATEST EXAM 2024 WITH 100% CORRECT SOLUTIONS BEST GRADES GURANTEED
, 5. Quality of Care ---ANSWERS___ Quality Measures
Star Ratings
6. HEDIS ---ANSWERS___ Healthcare Effectiveness Data and
Information Set
7. CMS Stars Ratings ---ANSWERS___
8. QBPs ---ANSWERS___ Quality Bonus Payments
9. Quality Bonus Payments ---ANSWERS___ 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.
10. CMS Demonstration Period ---ANSWERS___ 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.
CDEO CHAPTER 8 LATEST EXAM 2024 WITH 100% CORRECT SOLUTIONS BEST GRADES GURANTEED
, 11. Star Ratings ---ANSWERS___ 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
12. Stars Ratings ---ANSWERS___ 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.
13. Medicare Advantage Plans as well as Prescription Drug
Plans, are equally tasked with these quality measures.
14. Medicare Advantage HMO Plan Part C: Domain 1 --
ANSWERS___ Domain 1: Staying Healthy- Screenings, Test, and
Vaccines (7 Measures)
• Breast Cancer Screening
• Colorectal Cancer Screeening
• Annual Flu Vaccine
• Improving or Maintaining Physical Health
• Improving or Maintaining Mental Health
• Monitoring Physical Activity Adult BMI Assessment
CDEO CHAPTER 8 LATEST EXAM 2024 WITH 100% CORRECT SOLUTIONS BEST GRADES GURANTEED
