CPB (Certified Professional Biller) Certification Practice Exam

What does HEDIS stand for in the context of healthcare?

1. Health Insurance claim number

2. Health Insurance portability and accountability Act of 1996

3. Health Plan Employer Data and Information Set

4. Healthcare Common Procedure Coding System

The correct answer is: Health Plan Employer Data and Information Set

The correct answer is C, which stands for Health Plan Employer Data and Information Set. HEDIS is a set of standardized performance measures developed by the National Committee for Quality Assurance (NCQA) to ensure that health plans provide a baseline for evaluating their performance in various aspects of care and service. This framework allows healthcare organizations to measure and compare the quality of care provided to patients, thereby facilitating improvements and ensuring accountability in healthcare delivery. This context is vital because HEDIS is widely used in the healthcare industry to assess the quality of care and service provided by health plans, which influences benchmarking, reporting, and potential payer decisions. Being familiar with HEDIS is crucial for professionals in medical billing, as it ties into quality metrics that could affect reimbursement rates and contractual negotiations with insurance payers.