HEDIS & Star Rating Measures Flashcards
7 cards from real CCP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 HEDIS & Star Rating Measures flashcards as text
A chronic care professional is helping a plan improve its Stars. Which intervention is MOST directly linked to improving the Colorectal Cancer Screening (COL) measure?
Answer: Outreach to members aged 45–75 who lack documentation of a qualifying screening
The COL HEDIS measure requires documented colorectal cancer screening, so proactive outreach to close care gaps in eligible members directly improves measure rates.
What is the measurement period for most annual HEDIS measures?
Answer: January 1 through December 31 of the measurement year
Most HEDIS measures use a January 1 through December 31 measurement year, with data submitted to NCQA the following year.
Which Star Ratings measure category specifically evaluates health plan customer service and appeals handling?
Answer: Plan administration measures
Plan administration measures in the CMS Star Ratings system assess member appeals, grievances, and customer service quality.
The HEDIS measure 'Persistence of Beta-Blocker Treatment After a Heart Attack (PBH)' requires what duration of continuous therapy?
Answer: 6 months
The PBH measure requires that members who experienced an AMI remain on beta-blocker therapy for at least 6 months following hospital discharge.
A plan's Star Rating dropped from 4 to 3.5 stars. What is the MOST likely financial consequence?
Answer: Loss of Quality Bonus Payment eligibility
Plans that fall below 4 stars lose access to Quality Bonus Payments, which represent significant additional revenue from CMS.
Which HEDIS measure addresses statin use in individuals with cardiovascular disease?
Answer: Statin Therapy for Patients with Cardiovascular Disease (SPC)
The SPC measure evaluates the percentage of male and female members aged 21–75 with cardiovascular disease who were prescribed and remained on statin therapy.
In the context of HEDIS, what does 'denominator exclusion' mean?
Answer: Removing members who are clinically ineligible or have a documented medical reason for not receiving a service
Denominator exclusions remove members with valid clinical, medical, or other specified reasons that make the measure inapplicable, ensuring fair and accurate rate calculation.