The original impetus of HMO development came from which of the following?

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