CDEO Chapter 8 Study Guide with Complete Solutions
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Course
CDEO
Institution
CDEO
CDEO Chapter 8 Study Guide with
Complete Solutions
PREDICTIVE MODELING - Answer️️ -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
Suspect Logic - Answer️️ -Many organizations utilize a ...
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.
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.
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
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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