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CDEO Chapter 8 2023 /Questions With Verified Answers (A+)
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CDEO Chapter 8 2023 /Questions With VerifiedAnswers (A+)
Quiz :PREDICTIVE MODELING - √Answer :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
Quiz :Suspect Logic - √Answer :Many organizations utilize a method such as
this one to uncover diagnoses which are likely present but unreported or
unknown
Quiz :Chart Reviews - √Answer :Analysis of the information identified is used
to target retrospective reviews to capture any unreported diagnoses
Quiz :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
Quiz :Quality of Care - √Answer :Quality Measures
Star Ratings
Quiz :HEDIS - √Answer :Healthcare Effectiveness Data and Information Set
Quiz :CMS Stars Ratings - √Answer :
Quiz :QBPs - √Answer :Quality Bonus Payments
Quiz :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.
Quiz :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.
Quiz :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
Quiz :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.
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