What's The Process?
How do you successfully exit an over-read in rateMAX?
Save and Confirm.
An A1c of 8.6 is considered compliant?
True. An a1c of LESS than 9 is considered compliant, since this is the criteria for STAR ratings.
Who can complete a medication reconciliation?
RN, prescribing practitioner, or clinical pharmacist
True or false: If found, exclusions must be reported?
True
When working a member in the rateMAX module, what is the first thing you should review?
Member compliancy.
Where can you locate the official measure training material?
Education and Training Resource center
COA: A member is compliant if both pain screen and functional status assessment gaps are closed?
False. A member is considered compliant for COA if med review and pain screen are met.
Who can complete a compliant PE visit?
Anyone, There are no provider restrictions for Patient engagement
What exclusions apply to both COA and TRC?
Members who die within the MY and Hospice
True or False: If a member is in the COA or TRC measure, you would view the chart in OQGA.
False, COA and TRC charts are to be viewed in Onbase.
To activate a rateMAX shell chase, where would you locate the provider TIN?
From the claim
GSD is a triple-weighted measure.
True. GSD as well as CBP, carry more weight than the other measures.
How many components are required for RDI
6
True or false: Hospice care and Palliative care are the same thing and should be reported as an exclusion?
False, Palliative care is not the same as Hospice
True or False: A ticket needs to be created if an abstraction error is found during a formal over-read of a COA or TRC chart.
False.
Member with completed chases and an eligible over-read: these do not need a ticket. Once you complete the over-read in the queue, the abstraction team is notified.
What would a member's blood pressure reading be if they are considered, "adequately controlled?"
<140/90mm.
True or false: Telehealth data is acceptable for all TRC numerators?
False, Telehealth is not acceptable for NIA or RDI
True or False: A TRC member with a discharge date of 12/1 should be excluded?
False, the member must remain inpatient through 12/1 to be excluded.
When overreading a TRC chart, how many data entry points would you add?
5
What two systems are used to view charts?
Onbase and OQGA
If a member had a retinal eye exam completed in the MY, the result needs to be negative in order to be compliant?
False. Numerator compliancy is met when an eye screening is performed in the measurement year (regardless of result) or through a negative retinal or dilated eye exam in the year prior to the MY.
What additional documentation do you need to see in order to utilize a faxed Discharge summary for RDI?
There must be evidence of when the documentation was placed in the outpatient medical record.
True or False: TRC members who reside in an Assisted Living facility through 12/1 should be excluded?
False, assisted living is not considered an acute inpatient facility.
Before selecting the chart image in OQGA, what do you need to ensure matches with the over-read screen in rateMAX?
Verify that the HRChase ID of the chart in OQGA the HRChase ID in the over-read screen.