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HOM 5307 Exam 1 Set 5 |Questions and Answers

T/F An IPA is an HMO that contracts directly with physicians and hospitals. - ANSWER False An IPA is an HMO that contracts with physicians, then health plan. An HMO contracts directly with hospital (A direct contract Open Panel HMO contracts directly with physicians and hospitals) T/F The defining feature of a direct contract model is the HMO contracting directly with a hospital to provide acute services to its members - ANSWER false the defining feature of a direct contract model is ...

Behavioral change tools include all but which of the following? Analytics Termination from the network Mission clarity Communications - ANSWER Termination from the network Fee-for-service physicians are financially rewarded for good disease management in most environments. T or F - ANSWER False The Managed care backlash resulted in which of the following? A reduction in HMO membership New federal and state laws and regulations Reduced administrative costs - ANSWER A reduction i...

HOM 5307 Exam 1 Set 3 Exam Questions and Answers

State mandated benefits laws apply to self-funded employee benefits plans. - ANSWER False ERISA applies only to self-funded health plans. - ANSWER False ERISA requires expedited review for claims involving urgent care. - ANSWER True State mandated benefits laws apply to self-funded employee benefits plans. - ANSWER False ERISA preempts all state laws. - ANSWER False What is the most significant piece of social legislation since 1965? - ANSWER The Patient Protection & Affordable Ca...

HOM 5307 - test 2 Exam Questions and Answers 100% Scores

HOM 5307 – Final Exam Questions with Accurate Answers

Each of the following is a traditional way to group a member, except: Answers: A. Gender B. Claims experience C. Lifestyle D. B & C - ANSWER D T/F: Process measures of health care performance focus on the context in which care and services are not provided. - ANSWER T Which of the following is the leading reason for member complaints? Answers: A. Enrollment issues such as a missing ID card B. Interactions with their PCP C. Lack of coverage D. Claims issues - ANSWER D T/...

HOM 5307 Exam 2 Set 1 |20 Questions and Answers

T/F: State mandated laws apply to self-funded employee benefits plans - ANSWER FALSE T/F: ERISA applies only to self-funded health plans - ANSWER FALSE T/F: ERISA requires expedited review for claims involving urgent care - ANSWER TRUE T/F: ERISA preempts all state laws - ANSWER FALSE T/F: Given the low payment rates in Medicaid, there is no interest in developing incentive or pay for performance programs - ANSWER FALSE T/F: Consumers and small employers may shop for and purchase he...