CPB (Certified Professional Biller) Certification Practice Exam

Which organization is denoted by the acronym EQRO in the context of healthcare quality assessment?

1. Explanation of Benefits

2. External Quality Review Organization

3. Electronic Healthcare Network Accreditation Commission

4. Employer Group Health Plan

The correct answer is: External Quality Review Organization

The correct answer signifies that EQRO stands for External Quality Review Organization. Such organizations play a crucial role in the healthcare system, particularly in assessing the quality of care provided to Medicaid beneficiaries. By conducting independent assessments of Managed Care Organizations (MCOs), EQROs help ensure compliance with federal and state regulations, enhancing accountability and quality standards in healthcare delivery. This aligns with the broader objectives of improving healthcare outcomes and maintaining high standards of service delivery. In contrast, the other options represent different aspects of healthcare management and compliance. The Explanation of Benefits refers to a document provided by payers to explain what services were covered and any patient responsibility, but it does not focus on quality assessment. The Electronic Healthcare Network Accreditation Commission is involved in the accreditation of electronic healthcare networks, which is distinct from quality reviews. Lastly, an Employer Group Health Plan pertains to healthcare coverage provided by employers, rather than organizations dedicated to reviewing and improving quality in care delivery.