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HSA Exam 3 – Questions With Detailed Solutions
HSA Exam 3 – Questions With Detailed Solutions
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Voorbeeld 2 van de 7 pagina's
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Voorbeeld van de inhoud
HSA Exam 3 – Questions With Detailed SolutionsWhen Medicare pays a premium per member that is based on the member's
county of residence, it is called a(n): Correct Ans - risk plan
What is a risk plan Correct Ans -
What are limited benefit plans? Correct Ans - They only provide
one or two Medicaid benefits.
True or False? HEDIS is a data set of healthcare plans' service activities and
is used to evaluate healthcare plans. Although submission is voluntary,
nearly 100% of health plans submit their data to Correct Ans - true
What is HEDIS? Correct Ans - Healthcare Effectiveness Data and
Information Set
True or False? Managed care gatekeepers are the first point of contact with
a managed care patient. Correct Ans - False
True or False? Health maintenance organizations (HMOs) are the oldest
type of managed care. Members must see their primary care provider first
in order to see a specialist. Correct Ans - true
True or False? The fee-for-service (FFS) system was the traditional health
insurance plan that paid a fee for a service provided by the provider. This
system increased healthcare costs because there was no limit as to how
much a provider could charge for a service. Correct Ans - true
_________ are a type of HMO and have similar rules to Medicare Advantage
plans. CMS reimburses the MCOs on a preset monthly basis per enrollee
based on a forecasted budget. Correct Ans - Medicare cost plans
________ is an evaluation of services once the services have been provided.
This may occur to assess treatment patterns of certain diseases.
Correct Ans - Retrospective utilization review
Describe what a health maintenance organization (HMO) is and list the four
different types of HMO models. Correct Ans - HMOs are the oldest
, type of managed care. Members must see their primary care provider first
in order to see a specialist.
What are the five common characteristics of managed care organizations
(MCOs)? Correct Ans - -They all establish relationships with
organizations and providers to provide a designated set of services to their
members.
-They all establish criteria for their members to utilize the MCO.
-They all establish measures to estimate cost control.
-They all provide incentives to encourage health service resources
.
-They all provide and encourage utilization of programs to improve the
health status of their enrollees.
what are the four types of HMO MODELS Correct Ans - The four
types of HMO models are staff, group, network, and independent practice
association.
what is the staff model? Correct Ans - The staff model hires
providers to work at a physical location.
what is the group model Correct Ans - The group model negotiates
with a group of physicians exclusively to perform services.
what is the network model Correct Ans - The network model is
similar to the group model but these providers may see other patients who
are not members of the HMO. There is a negotiated rate for service for
members to see providers who belong to the network.
What is the independence practice association? Correct Ans - The
independent practice association (IPA) contracts with a group of physicians
who are in private practice to see MCO members at a prepaid rate per visit.
The physicians may sign contracts with many HMOs. The physicians may
also see non-HMO patients. This type of HMO was a result of the HMO Act
of 1973.
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