QIA Exclusions
What is a QIA exclusion:
A) Expenditure or activity that must not be included in quality improving activities
B) Expenditure or activity that must be included in quality improving activities
C) Expenditure or activity that enhances the the health quality of our members
D) Expenditure or activity to reduce our taxable income
A) Expenditure or activity that must not be included in quality improving activities
When was QIA established here at Aetna?
A. 2008
B. 2010
C. 2016
D. 2017
C. 2016
Who do we submit MLR filings to:
A) State Treasurer
B) Ken Jennings
C) CMS (Centers for Medicare and Medicaid Services)
D) Alan Roberts
C) CMS (Centers for Medicare and Medicaid Services)
What does QIA stand for?
A. Quarterly Investment Accounting
B. Quality Improvment Action
C. Quality Improving Activity
D. Quantified Improvement Activity
C. Quality Improving Activity
How often do we perform QIA data collection in Medicare?
A. 12 times, monthly
B. 4 times, quarterly
C. 365 times, daily
D. 2 times, bi-annually
D. 2 times, bi-annually
Which of the following activities would be included in QIA:
A) Credentialing
B) Case Management Activities
C) Dog walking program
D) Claims Adjudication
E) Provider contracting
B) Case Management Activities
By estimate, how many dollars Aetna files as QIA each year?
A. Thousands
B. Millions
C. Billions
D. Trillions
B. Millions
What act requires health insurers to report MLR filings:
A) Americans with Disabilities Act
B) Affordable Care Act
C) Freedom of Information Act
D) act of kindness
B) Affordable Care Act
Which of the following are NOT one of the 6 Categories of QIA:
A. Preventing hospital readmissions
B. Resources for living
C. Improving patient safety
D. Fraud detection
B. Resources for living
What is our QIA growth goal this year?
A. 311.0%
B. 31.1%
C. 6.0%
D. 9.7%
C. 6.0%
The following is a list of exclusions except:
A) Activities designed primarily to control or contain costs
B) Enrollee and Provider appeals and grievances
C) Concurrent and Retrospective Review
D) Patient-centered interventions (i.e. making or verifying appointments)
E) Benefit administration
D) Patient-centered interventions (i.e. making or verifying appointments)
What are some initiatives that have been classified as QIA?
A. Flu Shot Reminders
B. Member Health Story Booklets
C. Medication Adherence Programs
D. All of the above
D. All of the above
What MLR % are health insurers required to meet for MA MLR:
A) 80%
B) 8.5%
C) as much as they can
D) 85.0%
D) 85.0%
We know that MLR results determine if any given Medicare contract goes into rebate. How does QIA impact MLR?
A. QIA spending can decrease the MLR to avoid a rebate
B. QIA spending can increase the MLR to avoid a rebate
C. There is no relationship between QIA and MLR
D. MLR impacts QIA but QIA does not impact MLR
B. QIA spending can increase the MLR to avoid a rebate
How much QIA did Medicare report for the 2018 Plan Year?
A. $294 million
B. $313 thousand
C. ($216) million
D. $2.9 billion
A. $294 million
Not included in QIA:
A) Activities paid for with grant money
B) Marketing expenses
C) toothbrushes
D) all of the above
E) A and B only
E) A and B only
What are some factors QIA can influence?
A. MLR Exposure
B. Star Ratings
C. Members' Health
D. All of the above
D. All of the above
Approximately what portion of premium does QIA make up in an MLR calculation:
A)1%-2%
B) all of it
C) 5%-10%
D) 10%-15%
A)1%-2%
Which is NOT part of documenting the 4 part test?
A. Measure the impact of the activty on our members health
B. Identify evidence based medicine showing the activity improves health
C. Explain how the activity improves health quality
D. Provide financial documentation and proof of payment for the activity
D. Provide financial documentation and proof of payment for the activity
What kinds of QIA do we collect?
A. Vendor expenses
B. Employee expenses
C. Administrative expenses
D. IT Expenses
C. Administrative expenses
The list of exclusions can be found:
A) 45 CFR 158.150
B) on Amazon
C) 45 CFR 123.456
D) no one knows
A) 45 CFR 158.150
How much growth was reported in QIA for the 2019 Reporting Year?
A. 9%
B. 17%
C. 45%
D. None of the above
A. 9%
Approximately how many H-contracts will we file MLR for in 2020 for CY19, this includes both MA and PDP contracts:
A) 87
B) 30
C) as many as we can
D) 15
B) 30
Which QIA category is exempt from the four part test?
A. Fraud reduction
B. Health information technology
C. Wellness
D. All categories of QIA must meet the four part test
A. Fraud reduction
How much of Medicare QIA is directly owned by the Medicare organization?
A. 80%
B. None of it
C. All of it
D. About half
D. About half