CEBS GBA 2 STUDY GUIDE TERMINAL
CERTIFICATION EVALUATION COMPLETE
QUESTIONS WITH FULL SOLUTION
ALREADY PASSED
⩥ Insurance identification (ID) card information
Answer: CAA requires plans and issuers of insurance identification (ID)
cards to include in clear writing on any physical or electronic plan or
insurance ID card issued to participants, beneficiaries, or enrollees, any
applicable deductibles, any applicable out-of-pocket maximum
limitations, and a telephone number and website address for individuals
to seek consumer assistance.
⩥ Good faith estimate
Answer: Expected charges for the scheduled item or service and any
items or services reasonably expected to be provided in conjunction with
those items and services, including those provided by another provider
or facility, with the expected billing and diagnostic codes for these items
and services.
⩥ Advanced explanation of benefits (AEOB)
Answer: Network status of provider or facility; Contracted rate for item
or service or description how to obtain information on participating
providers and facilities; Good faith estimate from provider; good faith
,estimate amount of plan payment and amount of cost-sharing the
individual pays; Disclaimers medical management techniques.
⩥ Gag clause prohibitions
Answer: Providing provider-specific cost or quality of care information
or data to referring providers, plan sponsor, participants, beneficiaries,
enrollees, individuals eligible to become participants, beneficiaries,
enrollees of the plan or coverage; Electronically accessing de-identified
claims and encounter data for each participant, beneficiary, or enrollee;
Sharing such information, consistent with applicable privacy regulations.
⩥ Provider directory information accuracy
Answer: If given inaccurate information, the plan or issuer cannot
impose a cost-sharing amount greater than the cost-sharing amount that
would be imposed for items and services furnished by a participating
provider or facility and must count cost-sharing amounts toward any in-
network deductible or in-network out-of-pocket maximum.
⩥ Continuity of care
Answer: Protections ensure continuity of care in instances when
terminations of certain contractual relationships result in changes in
provider or facility network status.
⩥ Absence of grandfathered health plan exemptions
,Answer: CAA did not include an exception for grandfathered health
plans that was comparable to this provision of the ACA.
⩥ Reporting of pharmacy benefits and drug costs
Answer: Requiring that plans and issuers submit relevant information to
the Departments. Includes general information regarding the plan or
coverage.
⩥ Quality
Answer: The degree to which health services for individuals and
populations increase the likelihood of desired health outcomes and are
consistent with current professional knowledge.
⩥ Safety
Answer: The prevention of harm to patients.
⩥ Patient safety
Answer: Freedom from accidental or preventable injuries produced by
medical care.
⩥ A personal philosophy of excellence
Answer: Quality and excellence are things we do automatically, not just
because of rules, regulations, processes or policies but because quality
and excellence are part of who we are.
, ⩥ Significance of the red bead experiment
Answer: Failure is not the result of the participants' performance but
rather a bad process.
⩥ Zero-gravity thinkers
Answer: People who might have little expertise about a particular
problem or situation but who offer fresh ideas that are not bound by an
existing knowledge base
⩥ System of Profound Knowledge (Deming)
Answer: Knowledge of the system, knowledge of psychology, the theory
of knowledge, and knowledge of variation.
⩥ Institute of Medicine (IOM) landmark studies
Answer: Reports estimated 98,000 people each year die as a result of
medical errors in U.S. hospitals and preventable adverse events account
for about $8.8 billion in health care spending. The reports called for
immediate action to address the problem of medical errors and to create
a culture of safety and quality in health care organizations.
⩥ Total quality management (TQM)
Answer: A management approach to long-term success through
customer satisfaction. All members of an organization participate in
CERTIFICATION EVALUATION COMPLETE
QUESTIONS WITH FULL SOLUTION
ALREADY PASSED
⩥ Insurance identification (ID) card information
Answer: CAA requires plans and issuers of insurance identification (ID)
cards to include in clear writing on any physical or electronic plan or
insurance ID card issued to participants, beneficiaries, or enrollees, any
applicable deductibles, any applicable out-of-pocket maximum
limitations, and a telephone number and website address for individuals
to seek consumer assistance.
⩥ Good faith estimate
Answer: Expected charges for the scheduled item or service and any
items or services reasonably expected to be provided in conjunction with
those items and services, including those provided by another provider
or facility, with the expected billing and diagnostic codes for these items
and services.
⩥ Advanced explanation of benefits (AEOB)
Answer: Network status of provider or facility; Contracted rate for item
or service or description how to obtain information on participating
providers and facilities; Good faith estimate from provider; good faith
,estimate amount of plan payment and amount of cost-sharing the
individual pays; Disclaimers medical management techniques.
⩥ Gag clause prohibitions
Answer: Providing provider-specific cost or quality of care information
or data to referring providers, plan sponsor, participants, beneficiaries,
enrollees, individuals eligible to become participants, beneficiaries,
enrollees of the plan or coverage; Electronically accessing de-identified
claims and encounter data for each participant, beneficiary, or enrollee;
Sharing such information, consistent with applicable privacy regulations.
⩥ Provider directory information accuracy
Answer: If given inaccurate information, the plan or issuer cannot
impose a cost-sharing amount greater than the cost-sharing amount that
would be imposed for items and services furnished by a participating
provider or facility and must count cost-sharing amounts toward any in-
network deductible or in-network out-of-pocket maximum.
⩥ Continuity of care
Answer: Protections ensure continuity of care in instances when
terminations of certain contractual relationships result in changes in
provider or facility network status.
⩥ Absence of grandfathered health plan exemptions
,Answer: CAA did not include an exception for grandfathered health
plans that was comparable to this provision of the ACA.
⩥ Reporting of pharmacy benefits and drug costs
Answer: Requiring that plans and issuers submit relevant information to
the Departments. Includes general information regarding the plan or
coverage.
⩥ Quality
Answer: The degree to which health services for individuals and
populations increase the likelihood of desired health outcomes and are
consistent with current professional knowledge.
⩥ Safety
Answer: The prevention of harm to patients.
⩥ Patient safety
Answer: Freedom from accidental or preventable injuries produced by
medical care.
⩥ A personal philosophy of excellence
Answer: Quality and excellence are things we do automatically, not just
because of rules, regulations, processes or policies but because quality
and excellence are part of who we are.
, ⩥ Significance of the red bead experiment
Answer: Failure is not the result of the participants' performance but
rather a bad process.
⩥ Zero-gravity thinkers
Answer: People who might have little expertise about a particular
problem or situation but who offer fresh ideas that are not bound by an
existing knowledge base
⩥ System of Profound Knowledge (Deming)
Answer: Knowledge of the system, knowledge of psychology, the theory
of knowledge, and knowledge of variation.
⩥ Institute of Medicine (IOM) landmark studies
Answer: Reports estimated 98,000 people each year die as a result of
medical errors in U.S. hospitals and preventable adverse events account
for about $8.8 billion in health care spending. The reports called for
immediate action to address the problem of medical errors and to create
a culture of safety and quality in health care organizations.
⩥ Total quality management (TQM)
Answer: A management approach to long-term success through
customer satisfaction. All members of an organization participate in
