HOM 5307 EXAM 1 SET 2 QUESTIONS
AND ANSWERS 100% SOLVED.
Key common characteristics of PPOs include: - ANSWER Selected provider panels
Negotiated payment rates
Consumer choice &
Utilization management
EPOs share similarities with: - ANSWER PPOs and HMOs
Commonly recognized HMOs include: - ANSWER IPAs
Capitation is usually defined as: - ANSWER Prepayment for services on a fixed, per
member per month basis
In what model does an HMO contract with more than one group practice provide
medical services to its members? - ANSWER Network model
Advantages of an IPA include: - ANSWER Broader physician choice for members
T or F: Hospital consolidation has been blocked more often than not by the Department
of Justice (DOJ) and/or the Federal Trade Commission (FTC). - ANSWER False
T or F: Managed care plans perform onsite reviews of hospitals and ambulatory surgical
centers. - ANSWER False
Who has final responsibility for all aspects of an independent HMO? - ANSWER Board
of Directors
Medical Directors typically have responsibility for: - ANSWER Utilization management
Benefits determinations for appeals
Quality management
State and federal regulations consistently apply network access standards to: -
ANSWER POS plans and HMOs
Which organization(s) need a Corporate Compliance Officer (CCO)? - ANSWER
Hospitals &
Health plans with a Medicare Advantage risk contract
T or F: Board of Directors has final responsibility for all aspects of an independent HMO
- ANSWER True
T or F: In the medical management area, committees serve to diffuse some elements of
responsibility and allow important input from the field into procedure and policy or even
into case-specific interpretation of existing policy. - ANSWER True
AND ANSWERS 100% SOLVED.
Key common characteristics of PPOs include: - ANSWER Selected provider panels
Negotiated payment rates
Consumer choice &
Utilization management
EPOs share similarities with: - ANSWER PPOs and HMOs
Commonly recognized HMOs include: - ANSWER IPAs
Capitation is usually defined as: - ANSWER Prepayment for services on a fixed, per
member per month basis
In what model does an HMO contract with more than one group practice provide
medical services to its members? - ANSWER Network model
Advantages of an IPA include: - ANSWER Broader physician choice for members
T or F: Hospital consolidation has been blocked more often than not by the Department
of Justice (DOJ) and/or the Federal Trade Commission (FTC). - ANSWER False
T or F: Managed care plans perform onsite reviews of hospitals and ambulatory surgical
centers. - ANSWER False
Who has final responsibility for all aspects of an independent HMO? - ANSWER Board
of Directors
Medical Directors typically have responsibility for: - ANSWER Utilization management
Benefits determinations for appeals
Quality management
State and federal regulations consistently apply network access standards to: -
ANSWER POS plans and HMOs
Which organization(s) need a Corporate Compliance Officer (CCO)? - ANSWER
Hospitals &
Health plans with a Medicare Advantage risk contract
T or F: Board of Directors has final responsibility for all aspects of an independent HMO
- ANSWER True
T or F: In the medical management area, committees serve to diffuse some elements of
responsibility and allow important input from the field into procedure and policy or even
into case-specific interpretation of existing policy. - ANSWER True
