HOM 5307 Managing Healthcare
Organizations; Final Test (3) |Q’s and A’s
State mandated benefits laws apply to self-funded employee benefits plans. -
-False
- ERISA applies only to self-funded health plans. - -False
- ERISA requires expedited review for claims involving urgent care. - -True
- State mandated benefits laws apply to self-funded employee benefits
plans. - -False
- ERISA preempts all state laws. - -False
- What is the single largest factor contributing to poor health outcomes? - -
Poverty
- which of the following is the leading reason for member complaints? - -
Claims issues
- The greatest volume of interactions between a health plan and its
members will occur by means of: - -Telephone
- The common reason cited by physicians for limiting their practice to
Medicaid consumers was low reimbursement rates. - -True
- Member services is responsible for what activities? - -Providing info to
members; Helping members with any problems; Handling member
grievances and complaints; Tracking and reporting patterns of problems
encountered; Enhancing the relationship between the members of the plan
and the plan itself
- What is the most significant piece of social legislation since 1965? - -The
Patient Protection & Affordable Care act of 2010
- Critical measures in the contact center include: - -Abandon rate
- Given the low payment rates in Medicaid, there is no interest in developing
incentives or pay for performance programs. - -False
- Consumers and small employers may shop for and purchase health
insurance through the exchange as a result of the children's health insurance
reauthorization act of 2009: - -False
Organizations; Final Test (3) |Q’s and A’s
State mandated benefits laws apply to self-funded employee benefits plans. -
-False
- ERISA applies only to self-funded health plans. - -False
- ERISA requires expedited review for claims involving urgent care. - -True
- State mandated benefits laws apply to self-funded employee benefits
plans. - -False
- ERISA preempts all state laws. - -False
- What is the single largest factor contributing to poor health outcomes? - -
Poverty
- which of the following is the leading reason for member complaints? - -
Claims issues
- The greatest volume of interactions between a health plan and its
members will occur by means of: - -Telephone
- The common reason cited by physicians for limiting their practice to
Medicaid consumers was low reimbursement rates. - -True
- Member services is responsible for what activities? - -Providing info to
members; Helping members with any problems; Handling member
grievances and complaints; Tracking and reporting patterns of problems
encountered; Enhancing the relationship between the members of the plan
and the plan itself
- What is the most significant piece of social legislation since 1965? - -The
Patient Protection & Affordable Care act of 2010
- Critical measures in the contact center include: - -Abandon rate
- Given the low payment rates in Medicaid, there is no interest in developing
incentives or pay for performance programs. - -False
- Consumers and small employers may shop for and purchase health
insurance through the exchange as a result of the children's health insurance
reauthorization act of 2009: - -False
