Quality Assurance & Standards Flashcards
7 cards from real CMS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Quality Assurance & Standards flashcards as text
Which CMS program uses star ratings to evaluate Medicare Advantage and Part D plan quality?
Answer: Five-Star Quality Rating System
The Five-Star Quality Rating System rates Medicare Advantage and Part D plans on a scale of 1 to 5 stars based on quality and performance measures.
What is the minimum star rating a Medicare Advantage plan must generally maintain to avoid sanctions under CMS quality standards?
Answer: 2.5 stars
Plans that receive less than 2.5 stars for three consecutive years may face low-performing plan designations and enrollment restrictions.
HEDIS measures used in Medicare quality reporting are developed and maintained by which organization?
Answer: NCQA
The National Committee for Quality Assurance (NCQA) develops and maintains HEDIS (Healthcare Effectiveness Data and Information Set) measures.
Under the Medicare Quality Payment Program, what does MIPS stand for?
Answer: Merit-based Incentive Payment System
MIPS (Merit-based Incentive Payment System) is a track within the Quality Payment Program that adjusts clinician payments based on performance scores.
Which measure category carries the most weight in MIPS scoring under the Quality Payment Program?
Answer: Quality
The Quality category historically carries the highest weight (30%) in MIPS composite performance scoring, though weights can change annually.
A Medicare Advantage plan receives a 5-star rating. Which special enrollment period does this unlock for beneficiaries?
Answer: Special Enrollment Period to switch any time during the year
Beneficiaries may enroll in a 5-star rated Medicare Advantage or Part D plan at any time during the year using a special enrollment period.
Which CMS initiative requires hospitals to publicly report quality measures and links payment to performance?
Answer: Hospital Value-Based Purchasing Program
The Hospital Value-Based Purchasing (VBP) Program adjusts Medicare payments to hospitals based on quality performance across multiple domains.