HOM 5307 Exam 4 Questions and Correct Verified
Answers
Behavioral change tools include all but which of the following?
Analytics
Termination from the network
Mission clarity
Communications
Termination from the network
Fee-for-service physicians are financially rewarded for good disease management in most
environments.
T or F
False
The Managed care backlash resulted in which of the following?
A reduction in HMO membership
New federal and state laws and regulations
Reduced administrative costs
A reduction in HMO membership
New federal and state laws and regulations
Which of the following is a typical complaint providers have about health plan provider
profiling?
I get different results using my own data
My patients are sicker than other providers' patients
The quality and cost measures used are not accurate enough
All the above
,The HMO Act of 1973 did contributed to the growth of managed care
T or F
True
Which of the following forms of hospital payment contain no elements of risk sharing by the
hospital?
DRGs and MS-DRGs
Per diem
Capitation
Sliding scale FFS
Sliding scale FFS
PSOs, created by the BBA of 1997, proved to be very popular and successful.
T or F
False
In January 2006, what large federal prescription drug program was implemented that offered
pharmacy benefits to more than 40 million people at that time and is expected to increase by
30% throughout the next decade?
The Department of Defense TRICOR program
Public Health Service and Indian Health Service
State Medicaid programs
Medicare Part D
Medicare Part D
Managed care is best described as:
A broad and constantly changing array of health plans employers, unions, and other
purchasers of care that attempt to manage cost, quality, and access to that care
A broad changing array of health plans employers, unions, and other purchasers of care.
, A constantly changing array of unions, and other purchasers of care that attempt to manage
cost, quality, and access to that care
A array of health plans employers, unions, and other purchasers of care that attempt to
manage cost, quality, and access to that care
A broad and constantly changing array of health plans employers, unions, and other purchasers
of care that attempt to manage cost, quality, and access to that care
Consolidation in the payer industry has resulted in most hospitals being unable to obtain
adequate rate increases.
T or F
False
Which organization(s) need a Corporate Compliance Officer (CCO)?
Hospitals
Health plans with a Medicare Advantage risk contract
Every organization that provides health care
Hospitals and Health plans with a Medicare Advantage risk contract
Health Plan Employer Data and Information Set is the less widely used set of measures for
reporting on managed behavioral health care.
T or F
False
The following term refers to an all-inclusive rate paid by the HMO for both institutional and
professional services:
Bundled payment
Per diem
Answers
Behavioral change tools include all but which of the following?
Analytics
Termination from the network
Mission clarity
Communications
Termination from the network
Fee-for-service physicians are financially rewarded for good disease management in most
environments.
T or F
False
The Managed care backlash resulted in which of the following?
A reduction in HMO membership
New federal and state laws and regulations
Reduced administrative costs
A reduction in HMO membership
New federal and state laws and regulations
Which of the following is a typical complaint providers have about health plan provider
profiling?
I get different results using my own data
My patients are sicker than other providers' patients
The quality and cost measures used are not accurate enough
All the above
,The HMO Act of 1973 did contributed to the growth of managed care
T or F
True
Which of the following forms of hospital payment contain no elements of risk sharing by the
hospital?
DRGs and MS-DRGs
Per diem
Capitation
Sliding scale FFS
Sliding scale FFS
PSOs, created by the BBA of 1997, proved to be very popular and successful.
T or F
False
In January 2006, what large federal prescription drug program was implemented that offered
pharmacy benefits to more than 40 million people at that time and is expected to increase by
30% throughout the next decade?
The Department of Defense TRICOR program
Public Health Service and Indian Health Service
State Medicaid programs
Medicare Part D
Medicare Part D
Managed care is best described as:
A broad and constantly changing array of health plans employers, unions, and other
purchasers of care that attempt to manage cost, quality, and access to that care
A broad changing array of health plans employers, unions, and other purchasers of care.
, A constantly changing array of unions, and other purchasers of care that attempt to manage
cost, quality, and access to that care
A array of health plans employers, unions, and other purchasers of care that attempt to
manage cost, quality, and access to that care
A broad and constantly changing array of health plans employers, unions, and other purchasers
of care that attempt to manage cost, quality, and access to that care
Consolidation in the payer industry has resulted in most hospitals being unable to obtain
adequate rate increases.
T or F
False
Which organization(s) need a Corporate Compliance Officer (CCO)?
Hospitals
Health plans with a Medicare Advantage risk contract
Every organization that provides health care
Hospitals and Health plans with a Medicare Advantage risk contract
Health Plan Employer Data and Information Set is the less widely used set of measures for
reporting on managed behavioral health care.
T or F
False
The following term refers to an all-inclusive rate paid by the HMO for both institutional and
professional services:
Bundled payment
Per diem
