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CDEO CHAPTER 8 LATEST EXAM 2024 WITH 100% CORRECT SOLUTIONS| BEST GRADES GURANTEED. . PREDICTIVE MODELING ---ANSWERS___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 ---ANSWERS___ Many organizations utilize a method such as this one to uncover diagnoses which are likely present but unreported or unknown . Chart Reviews ---ANSWERS___ Analysis of the information identified is used to target retrospective reviews to capture any unreported diagnoses . Suspect Logic Factors ---ANSWERS___ * Known/Expected clinical progression of an illness or disease e DME needs e PDE e Laboratory test findings e CPT codes reported during the year in review e HCPCS codes reported during the year in review e Socioeconomic status e Disability: Hospice: ESRD and other such statuses of the patient being reviewed 5. Quality of Care ---ANSWERS___ Quality Measures Star Ratings 6. HEDIS ---ANSWERS___ Healthcare Effectiveness Data and Information Set 7. CMS Stars Ratings ---ANSWERS___ 8. QBPs ---ANSWERS____ Quality Bonus Payments 9. Quality Bonus Payments ---ANSWERS___ 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. 10. CMS Demonstration Period ---ANSWERS____ 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. 11. Star Ratings ---ANSWERS____ the star ratings ranked plans ona calse from one to five stars, in half-star increments defined in the following manner 15. Medicare Advantage HMO Plan Part C: Domain 2 --- ANSWERS___ Domain 2: Managing Chronic Conditions (12 Measures) -SNP Care Management -Care for Older Adults - Medication Review -Care for Older Adults - Functional Status ---Assessment -Care for Older Adults - Pain Screening -OMW -CDC-EE -CDC- Kidney Disease Monitoring -CDC- Blood Sugar Control -CDC- Cholesterol Controlled e -CBP -RA Management -Reducing the Risk of Falling -Improving Bladder Control e -MRP -Plan All-Cause Readmissions 16. Medicare Advantage HMO Plan Part C: Domain 3 --- ANSWERS___ Domain 3: Member Experience with Health Plan (6 Measures) -Getting Needed Care -Getting Appointments and Care Quickly -Customer Service -Rating of Health Care Quality -Rating of Health Plan -Care Coordination 17. Medicare Advantage HMO Plan Part C: Domain 4 --- ANSWERS___ Member Complaints, Problems Getting Services, and Improvement in the Health Plan's Performance (4 Measures) -Complaints About the Health Plan -Members Choosing To Leave The Plan -Beneficiary Access and Performance Problems -Health Plan Quality Improvement 18. Medicare Advantage HMO Plan Part D: Domain 1 --- ANSWERS___ Domain 1: Drug Plan Customer Services (3 measures) -Call Center - Foreign Language Interpreter and TTY Availability -Appeals Auto-Forward -Appeals Upheld 19. Medicare Advantage HMO Plan Part D: Domain 2 --- ANSWERS___ Domain 2: Member Complaints and Changes in the Drug Plan's Performance (4 Measures) -Complaints About the Drug Plan -Members Choosing to Leave the Plan -Beneficiary Access and Performance Problems -Drug Plan Quality Improvement 27. Collecting HEDIS ---ANSWERS____ an incentive for many health plans to collect HEDIS data is a CMS requirement that health maintenance organizations submit Medicare HEDIS data to provide HMO services for Medicare enrollees under a program called Medicare Advantage 28. 91 HEDIS MEASURES ---ANSWERS____ 1. Effectiveness of Care 2. Access/Availability of Care 3. Experience of Care 4. Utilization and Relative Resource Use 5. Health Plan Descriptive Information 29. Measures are added, deleted, and revised annually. 30. HEDIS Data ---ANSWERS____ traditionally collected through surveys, medical chart reviews, and insurance claims from hospitalizations, medical office visits, and procedures 31. Survey measures must be conducted by an NCQA approved external survey organization. Clinical measure us the administrative or hybrid data collection methodology , as specified by NCQA. 32. Administrative Data ---ANSWERS___ are electronic records of services, including insurance claims and registration systems from hospitals, clinics, medical offices, pharmacies, and labs 33. NCQA---ANSWERS___ collaborates annualy with U.S. News and World Report to ran HMOs, using an index that combines many HEDIS measures and accreditation status. The "Best Health Plans" list is published in the magazine in October and is available on the magazine's web site. 34. HEDIS Measures ---ANSWERS___ focus on disease prevention, screening conditions across all body systems, patient access to care, patient satisfaction with care, and the performance of specific procedures and are settings. 35. MIPS Quality Performance ---ANSWERS____ this category offers the highest weight for reporting measures of 60% in the 2017 performance year, and is reduced to 50% by 2021. 36. *The maximum possible points to be earned in this cateorgy are 80-90, depending on group size. 37. MIPS ---ANSWERS___ clinicians are required to report six measures, down from nine in PQRS. One measure must be a cross- cutting measure, plus one outcome or high priority measure. 38. Clinicians can increase their scores by reporting more than six measures, or by reporting more than one outcome or high priority measure. 39. Quality Performance Measures ---ANSWERS___ There are 271 measures to choose from. 46. Option 1: Advancing Care Information Objectives and Measures 47. Option 2: 2017 Advancing Care Information Transition Objective and Measures 48. ACI Measures Examples ---ANSWERS___ 1. e-Prescribing- At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology 49. 2. Provide Patient Access - For at leas one unique patient seen by the MIPS eligible clinician: 1) The patient is provided timely access to view online, download, and transmit his or her health information: and 2) the MIPS eligible clinical ensures the patient's health information is available for the patient to access using any application of their choice that is configured to meet the technical specification of the Application Programming Interface API in the MIPS eligible clinician's certified EHR technology. 50. 3. Patient- Specific Education - The MIPS eligible clinician must use clinically relevant information from certified resources and provide electronic access to those materials to at-least one unique patient seen by the MIPS eligible clinician. 51. MIPS Clinical Improvement Activities ---ANSWERS___ New and worth 60 points. There are approximately 90 high and medium value measures, some worth 20 points and others worth 10 points each. This category accounts for 15% of the score for the 2017 performance year. 52. MIPS CIA---ANSWERS___ Clinicians are only required to report one activity, however, a clinician will need to perform additional measures to receive the maximum number of points. Many of the measure reflect activities clinicians have always done in their practices, such as timely communication of test results, or establishing care plans for patients. Participation in new practice models such as certified Patient Centered Medical Homes PCMH or an accountable care organization ACO, automatically raises the score in this category to full credit for PCMH and half credit for those in other advanced models. 53. Clinical Improvement Activities Measures ---ANSWERS____ Total of 92 activities in this category. 54. Most providers will attest to completing 4 improvement activities. Provider groups of less than 15 participants or in a rural of health shortage area will complete 2 activities. 55. Clinical Improvement Activities Examples: ---ANSWERS__ 1.) Care Transition Documentation Practice Improvements - Implementation of practices/processes for acre transition that include documentation of how a MIPS eligible clinician or group carried out a patient-centered action plan for first 30 days following a discharge 56. 2) Collection and Use of Patient Experience and Satisfaction Data on Access - Collection of patient experience and satisfaction data on access to care and development of an improvement plan, 64. The Medicare Quality Payment Program data for 2017 must be submitted by .---ANSWERS____ March 31, 2018 65. What are examples of Advancing Care Information (ACI): --- ANSWERS___ Providers have two options based on the provider's electronic health record edition. 66. Option 1: Advancing Care Information Objectives and 67. Measures 68. Option 2: 2017 Advancing Care Information Transition Objectives and Measures 69. Examples of Advancing Care Information Objective and Measures are: 70. e-prescribing 71. Provide Patient Access 72. Patient-Specific Education 73. Which of the following scenarios supports reporting 4064F-1P? ---ANSWERS____A patient diagnosed with MDD who has a poor medication interaction with his medication for HTN and antidepressants. 74. 1P is appended when the performance measure is not met due to medical reasons. Code 4064F is a Category II CPT® code that identifies a patient with MMD, MDD, ADOL who is prescribed an anti-depressant. 75. How can an independent provider report quality measures? --- ANSWERS___ Individual EPs may choose to report quality information through one of the following methods: 1. Medicare Part B claims 2. Qualified PQRS registry 3. Direct Electronic Health Record (EHR) using Certified EHR Technology (CEHRT) 4. CEHRT via Data Submission Vendor 5. Qualified clinical data registry (QCDR) 76. ***CMS web Interface is only available to groups of 25 or more, *** 77. What is the lowest star rating a plan must achieve to avoid penalties? ---ANSWERS___ Plans not obtaining 4 Stars or better may be penalized. 83. In review of Dr. N's paper based medical record system, you note that the doctor has documentation in a single encounter of HbA1c Testing and FOBT. Which two areas of HEDIS measures are most likely satisfied in this encounter and should prompt further review to confirm? ---ANSWERS___ The HBA1c test is to monitor diabetes. The FOBT is a screening test that qualifies for the colorectal cancer screening HEDIS measure. 84. Inamedical record review, which of the following ICD-10-CM codes would prompt satisfaction of the HEDIS measure of Pharmacotherapy Management of COPD Exacerbation and search for potential risk adjustment support. ---ANSWERS____ For this measure, COPD, emphysema and chronic bronchitis diagnoses support the measure. 85. STARS Ratings are important because they: ---ANSWERS__ STAR ratings is a measuring system for health plans. 86. Identify top performing health plans. 87. What are the four measures and activities that will be used to measure MIPS performance in 2018? ---ANSWERS____ Effective for the 2018 performance year, the provider score will be determined based on Quality, Improvement Activities, Advancing Care Information and Cost. 88. Which of the following is NOT a benefit for providers to utilize electronic health records? ---ANSWERS__ Electronic health records provide a lot of efficiencies for providers and help CDEO CHAPTER 8 LATEST EXAM 2024 WITH 100% CORRECT SOLUTIONS| BEST GRADES GUARANTEED.CDEO improve the continuity of care for the patient. Avoiding fraud and abuse should be a goal but regardless of the tool used for documentation, it will not prevent fraud and abuse if used inappropriately to alter documentation. 89. E-prescribing electronically transmits new and refill prescriptions to a community or mail order pharmacy. What is an advantage to E-Prescribing (eRx)? ---ANSWERS____ The provider can determine if a medication they want to prescribe is covered under the patient's insurance prior to sending an e-prescription. 90. Point of care provider access to the patient's payer formulary benefits. 91. Which of the following is a HEDIS measure for 2017? --- ANSWERS____I. Controlling high blood pressure 92. Il. Medication reconciliation post-discharge 93. Ill. Breast cancer screening 94. IV. Comprehensive Diabetes Care 95. All provided on the list are HEDIS measures. 96. HEDIS includes codes from which coding system? --- ANSWERS___|. CPT® CDEO CHAPTER 8 LATEST EXAM 2024 WITH 100% CORRECT SOLUTIONS| BEST GRADES GUARANTEED.CDEO 
