CPMSM Practice Tests / Extras

CPMSM Practice Tests / Extras What does HEDIS stand for? - Healthcare Effectiveness Data and Information Set What is HEDIS? - 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? - To understand what health plans are required to report in order to improve the quality of patient care HEDIS reporting is required by who? - NCQA & CMS Where is data collected for HEDIS? - 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. How can you improve HEDIS scores? - Health care providers can significantly improve HEDIS scores by submitting accurately coded claims for services provided and by maintaining accurate, legible, and complete medical records. Claims must reflect documentation within the medical record. The National Committee for Quality Assurance (NCQA) and the Centers for Medicare and Medicaid Services (CMS) require health plans to conduct a member satisfaction survey called ....? - CAHPS (Consumer Assessment of Healthcare Providers & Systems) What is the process of the surveys? - The surveys are mailed out in February and March with a telephonic follow-up for members that do not respond to the mailed survey. The results are usually available in July and August. How many questions in the CAHPS survey? - approximately 70 questions and measures the satisfaction of the member with the health plan, provider accessibility, patient/provider relationship and communication. CAHPS Questions include: - - Shared decision making (Commercial Measure) - Health promotion and education (Commercial Measure) - Coordination of care (Commercial Measure) - How well physician communicates (Commercial, Medicare, and Medicaid) - Getting care quickly (Commercial, Medicare, and Medicaid) - Getting needed care (Commercial, Medicare, and Medicaid - Rating of health care (Commercial, Medicare, and Medicaid) - Rating of personal physician (Commercial, Medicare, and Medicaid) - Rating of specialist (Commercial, Medicare, and Medicaid) - Ratings of health plan (Commercial, Medicare, and Medicaid) The CAHPS survey also contains questions regarding: - - whether the patient received the flu/pneumonia vaccine - directions on the use of aspirin - physician discussion on tobacco