How is predictive modeling to determine suspected diagnosis based on data
used in risk adjustment? elements.
Which of the following data d. I, II, III, and IV
elements are used in
predictive modeling?
I. DME claims
II. Prescription drug events
III. Physician claims data
IV. Facility claims data
a. III and IV
b. I, II, and IV
c. I, II, and III
d. I, II, III, and IV
What might happen as a a. Disease management programs
result of predictive
modeling?
a. Disease management
programs
b. Concurrent audits
c. Transporation benefits
d. Reduction in case
management
,In the CMS Star Ratings a. Outcomes
program, which measure is
given the highest weight?
a. Outcomes
b. Patient experience
c. Customer service
d. Accurate RAF scores
How often are HEDIS d. Annually
measures revised?
a. As needed
b. Monthly
c. Bi-annually
d. Annually
Which statement is TRUE b. Quality bonus payments are made to Medicare
regarding the CMS Stars Advantage plans who score at least four stars.
quality rating system?
a. Quality bonus payments
are made to physician who
score at least four stars.
b. Quality bonus payments
are made to Medicare
Advantage plans who score
at least four stars.
c. Quality bonus payments
are made to physician who
score at least five stars.
d. Quality bonus payments
are made to Medicare
Advantage plans who score
at least five stars.
,Merit-based Incentive c. I, II, III, and V
Payment System (MIPS)
includes which
performance categories?
I. Promoting
Interoperability
II. Cost
III. Improvement Activities
IV. Quantity
V. Quality
a. I and II
b. I, III, and V
c. I, II, III, and V
d. I, II, III, IV, and V
Which of the following are c. I, II, III, IV and V
domains in CMS Part C & D
Stars Rating?
I. Staying Healthy
II. Managing Chronic
Conditions
III. Member Experience with
Health Plans
IV. Member Complaints,
Problems Getting Services,
and Improvement in the
Health Plan's Performance
V. Health Plan Customer
Service
a. I, II and III
b. I, III, and V
c. I, II, III, IV and V
d. I, II, III and V
, What are the participation c. I and III
tracks available through
Medicare Access and CHIP
Reauthorization Act
(MACRA)?
I. Merit-based Incentive
Payment Systems
II. Sustainable Growth
System
III. Advanced Alternative
Payment Models
a. I
b. II and III
c. I and III
d. I, II and III
What is predictive a. An analytical review of known data elements to
modeling? establish a hypothesis related to the future health of
a. An analytical review of patients.
known data elements to
establish a hypothesis
related to the future health
of patients.
b. An analytical review of
payments to health plans to
determine the cost of future
healthcare.
c. An average of costs
associated with diagnoses
used to determine which
providers to contract with
for a health plan.
d. An average payment
associated with diagnoses
used to determine which
health plans providers
should contract with.
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