- Guides d'étude, Notes de cours & Résumés

HOM 5307 #2 exam questions and answers Technique is used by many pharmaceutical companies with health plans and PBMs to increase formulary access and utilization of specific products: - ANSWERS Rebates for preferred formulary position Health economic data, including a growing number of head-to-head clinical trials Member copayment coupons to offset copayments Recent legislation encourages separate lifetime limits for limits for behavioral care (T/F) - ANSWERS False The majority of p...

HOM 5307 ttu test 1 from practice-test Managed Care PPOs do not accept capitation risk and enrollees who are willing to pay higher cost sharing may access providers that are not in the contracted network. - ANSWERS True Blue Cross began how - ANSWERS 1929, Baylor for teachers in Houston, TX Blue Shield started how - ANSWERS as a physician service bureau in the 1930s BBA - ANSWERS Balanced Budget Act, 1997; Reduces payment level to Medicare and Choice plans in most of the country, below...

HOM 5307 Test 1 questions and correct answers An IPA is an HMO that contracts directly with physicians and hospitals. - ANSWERS False The defining feature of a direct contract model is the HMO contracting directly with a hospital to provide acute services to its members. - ANSWERS False HMOs are licensed as health insurance companies. - ANSWERS False A PHO is usually a separate business entity requiring the participation of a hospital and at least some of the hospitals admitting phys...

HOM 5307 Exam 2 Set 2 Exam Questions and Answers Behavioral change tools include all but which of the following? Analytics Termination from the network Mission clarity Communications - ANSWERS Termination from the network Fee-for-service physicians are financially rewarded for good disease management in most environments. T or F - ANSWERS False The Managed care backlash resulted in which of the following? A reduction in HMO membership New federal and state laws and regulations Red...

HOM 5307 Exam 1 questions with answers 2. The defining feature of a direct contract model is the HMO contracting directly with a hospital to provide acute services to its members (T,F) - ANSWERS False 3. Hospitals purchased physician practices and employed physicians in the 1990s, but will no longer do so (T,F) - ANSWERS False 6. The same methodology used to pay a hospital for inpatient care is usually also used to pay for outpatient care (T,F) - ANSWERS False 7. The majority of pres...

HOM 5307 Exam 1 questions and correct answers T/F An IPA is an HMO that contracts directly with physicians and hospitals. - ANSWERS 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 - ANSWERS false...

which of the following is the leading reason for member complaints? - ANSWER claims issues applicants/groups with poor credit histories may be required to do which of the following? - ANSWER produce some form of collateral, produce a letter of credit & pay premiums in advance of the coverage period todays transactional processing systems auto adjudicate on average what percentage of claims that are accepted into the processing system? - ANSWER 75% T/F although important, the provision o...

An IPA is an HMO that contracts directly with physicians and hospitals. - ANSWER False 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 HMOs are licensed as health insurance companies. - ANSWER False A PHO is usually a separate business entity requiring the participation of a hospital and at least some of the hospitals admitting physicians. - ANSWER True Hospitals purchased physici...

HOM 5307 Exam 1 Set 1 |Questions and Answers Distinction Graded

Key common characteristics of PPOs include: - ANSWER Selected provider panels Negotiated payment rates Consumer choice & Utilization management EPOs share similarities with: - ANSWER PPOs and HMOs Commonly recognized HMOs include: - ANSWER IPAs Capitation is usually defined as: - ANSWER Prepayment for services on a fixed, per member per month basis In what model does an HMO contract with more than one group practice provide medical services to its members? - ANSWER Network model ...