CDEO Chapter 8; Questions & Answers 100%
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PREDICTIVE MODELING Correct 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
Suspect Logic Correct Answer-Many organizations utilize a meth...
predictive modeling correct answer is an analytica
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CDEO Chapter 8; Questions & Answers 100%
Pass
PREDICTIVE MODELING Correct 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
Suspect Logic Correct Answer-Many organizations utilize a method such as
this one to uncover diagnoses which are likely present but unreported or
unknown
Chart Reviews Correct Answer-Analysis of the information identified is used
to target retrospective reviews to capture any unreported diagnoses
Suspect Logic Factors Correct 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
Quality of Care Correct Answer-Quality Measures
Star Ratings
, CDEO Chapter 8; Questions & Answers 100%
Pass
HEDIS Correct Answer-Healthcare Effectiveness Data and Information Set
CMS Stars Ratings Correct Answer-
QBPs Correct Answer-Quality Bonus Payments
Quality Bonus Payments Correct 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 Correct 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 Correct 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
Stars Ratings Correct 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.
Medicare Advantage Plans as well as Prescription Drug Plans, are equally tasked
with these quality measures.
Medicare Advantage HMO Plan Part C: Domain 1 Correct Answer-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
Medicare Advantage HMO Plan Part C: Domain 2 Correct Answer-Domain 2:
Managing Chronic Conditions (12 Measures)
-SNP Care Management
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