CRC Quality of Care Measures 2

Question 1

How does accurate risk adjustment coding impact a Medicare Advantage plan's Star Rating?

Accepted Answer

Accurate coding ensures quality measure denominator populations are correctly identified

Answer

Higher RAF scores automatically increase Star Ratings

Answer

Star Ratings are based solely on patient satisfaction

Answer

Risk adjustment has no connection to quality measurement

Question 2

How does risk adjustment data quality affect the HEDIS Controlling High Blood Pressure measure?

Accepted Answer

Accurate hypertension coding ensures all hypertensive members are in the denominator

Answer

No impact on blood pressure measures

Answer

Higher codes increase payment but decrease quality scores

Answer

Only pharmacy data affects blood pressure measures

Question 3

What is the relationship between RAPS and EDS for risk adjustment?

Accepted Answer

RAPS submits diagnosis codes only; EDS submits complete encounter data for both risk adjustment and quality measurement

Answer

RAPS and EDS are identical systems

Answer

EDS replaced RAPS entirely

Answer

RAPS is for quality; EDS is for risk adjustment only

Question 4

How can risk adjustment coding data support a heart failure readmission reduction initiative?

Accepted Answer

By identifying all HF members, their complication profiles, and risk stratification for targeted care management

Answer

By increasing RAF scores to generate revenue for programs

Answer

Risk adjustment data cannot be used for quality improvement

Answer

By coding HF at the highest severity level

Question 5

A plan's RAF scores increase year-over-year but health outcomes remain unchanged. What quality concern does this raise?

Accepted Answer

The pattern suggests coding intensity increases without corresponding clinical complexity changes

Answer

No concern, higher scores mean sicker population

Answer

Higher scores always indicate better documentation

Answer

Unchanged outcomes prove better preventive care

Question 6

Which HEDIS measure most directly depends on accurate mental health coding?

Accepted Answer

Follow-Up After Hospitalization for Mental Illness (FUH)

Answer

Breast Cancer Screening

Answer

Comprehensive Diabetes Care

Answer

Medication Reconciliation Post-Discharge