HOM 5307 Exam 3 Questions with
Solutions
Common types of health care fraud include: - -All of the above except D
- True or false? Durable Medical Equipment Suppliers are considered high
risk operations for fraud control. - -True
- True or False? Effective fraud control must include ongoing and agile
enhancements to efforts of fraud detection and prevention. - -True
- True or False? Fraud control effectiveness is easy to measure and assess. -
-False
- True or False? Health Care Fraud is not an issue for managed care
organizations. - -False
- True or False? Miami, Florida is known as the "ground zero" for health care
fraud. - -True
- Critical measures in the contact center include: - -Abandon rate
- Member services is responsible for all of the following activities, except: - -
Adjudicating claims
- The greatest volume of interactions between an health plan and its
members will occur by means of: - -Telephone
- True or False? Although important, the provision of general information to
members should not be considered to be one of the key aspects of member
services. - -False
- True or False? Appeal of coverage denial reviews are a distinctly formal
process governed by both state and federal laws. - -True
- True or False? It is important for all CSRs to be able to address all aspects
of plan operations. - -False
- True or False? Member services and membership services are synonymous
terms. - -False
- True or False? There is no legal distinction between a member complaint
and a grievance. - -False
Solutions
Common types of health care fraud include: - -All of the above except D
- True or false? Durable Medical Equipment Suppliers are considered high
risk operations for fraud control. - -True
- True or False? Effective fraud control must include ongoing and agile
enhancements to efforts of fraud detection and prevention. - -True
- True or False? Fraud control effectiveness is easy to measure and assess. -
-False
- True or False? Health Care Fraud is not an issue for managed care
organizations. - -False
- True or False? Miami, Florida is known as the "ground zero" for health care
fraud. - -True
- Critical measures in the contact center include: - -Abandon rate
- Member services is responsible for all of the following activities, except: - -
Adjudicating claims
- The greatest volume of interactions between an health plan and its
members will occur by means of: - -Telephone
- True or False? Although important, the provision of general information to
members should not be considered to be one of the key aspects of member
services. - -False
- True or False? Appeal of coverage denial reviews are a distinctly formal
process governed by both state and federal laws. - -True
- True or False? It is important for all CSRs to be able to address all aspects
of plan operations. - -False
- True or False? Member services and membership services are synonymous
terms. - -False
- True or False? There is no legal distinction between a member complaint
and a grievance. - -False
