HSA4109 FINAL TEST CORE QUESTIONS WITH SOLUTIONS
2025 GRADED A+
✔✔T/F Under the ACA, the first dollar coverage of preventive services is not mandatory,
meaning cost sharing is allowed when such services is provided by network providers -
✔✔False
✔✔This code set is used to code diagnoses and procedures for hospital patients
including visits to physician offices.
a.
ICD-10-CM
b.
HCPCS
c.
DRGs
d.
CPT-4
e.
None of the above - ✔✔ICD-10-CM
✔✔Coinsurance is:
a.
Money that a member must pay before the plan begins to pay.
b.
A fixed amount of money that a member pays for each office visit or prescription.
c.
Not a type of cost-sharing
d.
A percentage of the allowable charge that the member is responsible for paying. - ✔✔A
percentage of the allowable charge that the member is responsible for paying
✔✔The HMO Act of 1973 did which of the following for managed care?
a.
provided limited anti-trust immunity to insurers of certain activities
b.
gave states the power to regulate insurance
c.
All of the above
d.
made grants and loans available for the planning and start-up phases of new HMOs
e.
b and C only - ✔✔made grants and loans available for the planning and start-up phases
of new HMOs
, ✔✔Which of the following organizations have developed accreditation programs for
managed care organizations?
a.
URAC
b.
NCQA
c.
all of the above
d.
AAAHC
e.
(a) and (b) - ✔✔All of the above
✔✔Under capitation payment, the PMPM is $25.00 dollars, the PCP as 200 members in
the patient panel. What capitated amount will the physician receive?
a.
$2500
b.
$5000
c.
$25.00
d.
$1500 - ✔✔$5000
✔✔Examples of basic elements of credentialing typically include:
a.
Malpractice history
b.
Hospital privileges
c.
Board certification
d.
Medical license
e.
Onsite office inspection - ✔✔Onsite office inspection
✔✔Which of the following is not considered to be a type of defined health benefits plan?
a.
A self-funded employer plan
b.
A Health Savings Account
c.
Individual health insurance
d.
Medicare
2025 GRADED A+
✔✔T/F Under the ACA, the first dollar coverage of preventive services is not mandatory,
meaning cost sharing is allowed when such services is provided by network providers -
✔✔False
✔✔This code set is used to code diagnoses and procedures for hospital patients
including visits to physician offices.
a.
ICD-10-CM
b.
HCPCS
c.
DRGs
d.
CPT-4
e.
None of the above - ✔✔ICD-10-CM
✔✔Coinsurance is:
a.
Money that a member must pay before the plan begins to pay.
b.
A fixed amount of money that a member pays for each office visit or prescription.
c.
Not a type of cost-sharing
d.
A percentage of the allowable charge that the member is responsible for paying. - ✔✔A
percentage of the allowable charge that the member is responsible for paying
✔✔The HMO Act of 1973 did which of the following for managed care?
a.
provided limited anti-trust immunity to insurers of certain activities
b.
gave states the power to regulate insurance
c.
All of the above
d.
made grants and loans available for the planning and start-up phases of new HMOs
e.
b and C only - ✔✔made grants and loans available for the planning and start-up phases
of new HMOs
, ✔✔Which of the following organizations have developed accreditation programs for
managed care organizations?
a.
URAC
b.
NCQA
c.
all of the above
d.
AAAHC
e.
(a) and (b) - ✔✔All of the above
✔✔Under capitation payment, the PMPM is $25.00 dollars, the PCP as 200 members in
the patient panel. What capitated amount will the physician receive?
a.
$2500
b.
$5000
c.
$25.00
d.
$1500 - ✔✔$5000
✔✔Examples of basic elements of credentialing typically include:
a.
Malpractice history
b.
Hospital privileges
c.
Board certification
d.
Medical license
e.
Onsite office inspection - ✔✔Onsite office inspection
✔✔Which of the following is not considered to be a type of defined health benefits plan?
a.
A self-funded employer plan
b.
A Health Savings Account
c.
Individual health insurance
d.
Medicare
