CPB Certified Professional Biller Certification Practice Exam

What is the function of an EQRO?

1. To evaluate quality of health care services

2. To oversee patient payments

3. To manage electronic health records

4. To administer health insurance claims

The correct answer is: To evaluate quality of health care services

The correct choice focuses on the fundamental role of an External Quality Review Organization (EQRO), which is primarily tasked with assessing the quality of health care services provided to Medicaid beneficiaries. EQROs carry out independent evaluations to ensure compliance with established quality benchmarks and assess the overall performance of managed care organizations. This review process is crucial for identifying areas for improvement in health service delivery and ensuring that patients receive high-quality care. The other functions listed do not align with the primary responsibilities of an EQRO. Oversight of patient payments, management of electronic health records, and administration of health insurance claims are handled by other organizations or roles within the healthcare system, but are not part of the specific function of an EQRO. The emphasis of an EQRO is distinctly placed on evaluating and enhancing healthcare quality.