OTP 510 Final Exam UPDATED ACTUAL
Exam Questions and CORRECT Answers
The following describes this managed care principle: Panels of health care providers who are
contracted with the Managed Care Organization (MCO) provide services, are open or closed, and
go through a credentialing process. The primary care physician serves as a gatekeeper to
authorize services. - CORRECT ANSWER - Limited access to the universe of providers
The following describes this managed care product: This managed care product allows
individuals greater control over health utilization and spending. Co-payments, health savings
account, and high deductible plans often discourage overuse of services under this product. -
CORRECT ANSWER - Consumer-Directed Health Plans
The following describes this managed care product: This managed care product includes a
contract between providers and purchasers. Providers have an increased pool of patients while
beneficiaries have a choice of providers within the panel overall offering more choice and
flexibility. - CORRECT ANSWER - Preferred Provider Organizations (PPO)
The following describes this managed care product: This managed care product is a highly
aggregated form of managed care. It utilizes a gatekeeper to pre-approve. Beneficiaries access
with pre-approval only from providers on a panel - CORRECT ANSWER - Health
Maintenance Organizations (HMO)
There are 4 models of how provider contracts are established. The following describes this
model: This model includes a contract with individual providers or small provider groups.
Providers keep individual and group practices and see patients from multiple HMOs. -
CORRECT ANSWER - Independent Practice Associations
The following describes this Managed Care Payment Mechanism: Under this payment system
payments for treatments are separated. Providers are payed a set sum on a regular basis.
Financial risk is almost entirely on the provider - CORRECT ANSWER - Capitation
The following describes this managed care principle: Managed Care Organizations (MCOs)
perform utilization reviews, use benchmarking, and case management functions to evaluate the
, appropriateness of therapy services and coordinate care. - CORRECT ANSWER - Enhanced
quality control procedures
There are 4 models of how provider contracts are established. The following describes this
model: Within this model providers are employed by the HMO and receive a salary. The model is
highly integrated and beneficiaries must receive coverage at a fixed price within the HMO. -
CORRECT ANSWER - Staff Model
Managed Care limits access to providers with the following: - CORRECT ANSWER -
Credentialing
Gatekeeper
Open/Closed panels
The following criteria is required to be eligible for Medicare services EXCEPT: - CORRECT
ANSWER - Married and a past contributor to Medicare
This part of Medicare covers inpatient hospital care, short term skilled nursing facility care, and
home health care/hospice. - CORRECT ANSWER - Medicare Part A
This part of Medicare covers outpatient, home health, durable medical equipment, prosthetics,
and orthotics. Patients are responsible for 20% coinsurance rate under this part of Medicare. -
CORRECT ANSWER - Medicare Part B
The following are true about Medicare in Home Health EXCEPT: - CORRECT ANSWER -
OTs can complete the initial evaluation
The following is true about the Therapy Cap EXCEPT: - CORRECT ANSWER - OT and SLP
are lumped into the same category
Consider that the Utilization Review for fraud and abuse has three levels. The following
describes this level: This review occurs onsite and includes a review of patient documentation
and billing records. - CORRECT ANSWER - Level III
Exam Questions and CORRECT Answers
The following describes this managed care principle: Panels of health care providers who are
contracted with the Managed Care Organization (MCO) provide services, are open or closed, and
go through a credentialing process. The primary care physician serves as a gatekeeper to
authorize services. - CORRECT ANSWER - Limited access to the universe of providers
The following describes this managed care product: This managed care product allows
individuals greater control over health utilization and spending. Co-payments, health savings
account, and high deductible plans often discourage overuse of services under this product. -
CORRECT ANSWER - Consumer-Directed Health Plans
The following describes this managed care product: This managed care product includes a
contract between providers and purchasers. Providers have an increased pool of patients while
beneficiaries have a choice of providers within the panel overall offering more choice and
flexibility. - CORRECT ANSWER - Preferred Provider Organizations (PPO)
The following describes this managed care product: This managed care product is a highly
aggregated form of managed care. It utilizes a gatekeeper to pre-approve. Beneficiaries access
with pre-approval only from providers on a panel - CORRECT ANSWER - Health
Maintenance Organizations (HMO)
There are 4 models of how provider contracts are established. The following describes this
model: This model includes a contract with individual providers or small provider groups.
Providers keep individual and group practices and see patients from multiple HMOs. -
CORRECT ANSWER - Independent Practice Associations
The following describes this Managed Care Payment Mechanism: Under this payment system
payments for treatments are separated. Providers are payed a set sum on a regular basis.
Financial risk is almost entirely on the provider - CORRECT ANSWER - Capitation
The following describes this managed care principle: Managed Care Organizations (MCOs)
perform utilization reviews, use benchmarking, and case management functions to evaluate the
, appropriateness of therapy services and coordinate care. - CORRECT ANSWER - Enhanced
quality control procedures
There are 4 models of how provider contracts are established. The following describes this
model: Within this model providers are employed by the HMO and receive a salary. The model is
highly integrated and beneficiaries must receive coverage at a fixed price within the HMO. -
CORRECT ANSWER - Staff Model
Managed Care limits access to providers with the following: - CORRECT ANSWER -
Credentialing
Gatekeeper
Open/Closed panels
The following criteria is required to be eligible for Medicare services EXCEPT: - CORRECT
ANSWER - Married and a past contributor to Medicare
This part of Medicare covers inpatient hospital care, short term skilled nursing facility care, and
home health care/hospice. - CORRECT ANSWER - Medicare Part A
This part of Medicare covers outpatient, home health, durable medical equipment, prosthetics,
and orthotics. Patients are responsible for 20% coinsurance rate under this part of Medicare. -
CORRECT ANSWER - Medicare Part B
The following are true about Medicare in Home Health EXCEPT: - CORRECT ANSWER -
OTs can complete the initial evaluation
The following is true about the Therapy Cap EXCEPT: - CORRECT ANSWER - OT and SLP
are lumped into the same category
Consider that the Utilization Review for fraud and abuse has three levels. The following
describes this level: This review occurs onsite and includes a review of patient documentation
and billing records. - CORRECT ANSWER - Level III
