Question 1.1. (TCO B) The original impetus of HMO development came from which of the following? (Points : 5) Providers seeking patient revenues Consumers seeking access to healthcare Employers All of the above None of the above Question 2.2. (TCO A) Key common characteristics of PPOs include _____. (Points : 5) selected provider panels negotiated payment rates consumer choice utilization management All of the above A, B, and D only Question 3.3. (TCO B) Basic elements of credentialing include _____. (Points : 5) hospital privileges malpractice history medical license continuing medical education (CME) All of the above A, B, and C only Question 4.4. (TCO D) A common financial risk arrangement used as a performance-based incentive is _____. (Points : 5) carve-outs withholds per diem FFS Question 5.5. (TCO B) Which of the following forms of hospital reimbursement contain no elements of risk sharing by the hospital? (Points : 5) Capitation DRGs Per diem Sliding scale FFS Both C and D Question 6.6. (TCO C) Common sources of information to trigger DM include _____. (Points : 5) claims laboratory tests referrals from inpatient care coordinators pharmacy data electronic medical records All of the above A through D only Question 7.7. (TCO C) One potential negative consequence of drug formularies with high copayments is _____. (Points : 5) increased use of generic drugs increased use of brand drugs copayments may be a barrier to adherence. decreased use of the most cost-effective medications Question 8.8. (TCO C) Which of the following are components of a strong MCO prevention program? (Points : 5) Member benefits Services for members, such as health risk assessments Contracts with providers Public policies A and C only A, B, C, and D Question 9.9. (TCO D) This federal law has established specific, enforceable regulations regarding the standardization of electronic transactions and code sets for procedures and diagnoses. (Points : 5) OCR HEDIS HIPAA EMTALA Question 10.10. (TCO D) Employees who are engaged in their healthcare will do the following except what? (Points : 5) Have better compliance with health intervention programs Have lower healthcare costs Have higher productivity Have more direct reports Question 11.11. (TCO D) Which of the following does HIPAA regulate? (Points : 5) Electronic communications between payors and providers Portability and access standards Guaranteed renewability of group coverage All of the above Question 12.12. (TCO D) Which of the following clauses states that the provider agrees not to sue or assert any claims against the enrollee for services covered under the contract? (Points : 5) Flow down clause No-balance-billing clause Force majeure clause Hold-harmless clause
