HOM 5307 Test Practice Questions Answered 100%
Blue Cross began as a physician service bureau in the 1930s.
False
The BBA of 1997 resulted in a major increase in HMO enrollment.
False
The Managed care backlash resulted in:
A reduction in HMO membership
New federal/state regulations
PPOs differ from HMOs because they do not accept capitation risk and enrollees who are
willing to pay higher cost sharing may access providers that are not in the contracted
network.
True
Health care cost inflation has remained consistent since 1995.
False
Managed care plans perform onsite reviews of hospitals and ambulatory surgical centers.
False
Hospital consolidation has been blocked more often than not by the DOJ and/or the FTC.
False
The same methodology used to pay a hospital for inpatient care is usually also used to pay
for outpatient care.
, False
Fee-for-service payment is the most common method used by HMOs to pay specialists.
True
In markets with high levels of managed care penetration, hospitals are usually paid using
a sliding scare discount on charges method.
False
What forms of hospital payment contain no elements of risk sharing by the hospital?
Sliding Scale FFS
What are the basic ways to compensate open-panel PCPs?
Capitation & FFS
Consolidation in the payer industry has resulted in most hospitals being unable to
obtain adequate rate increases.
False
What term refers to an all-inclusive rate paid by the HMO for both institutional
and professional services?
Bundled Payment
Payment to a facility for outpatient procedures may be increased on a case-by-case basis
through:
Carve-outs
Capitation is a physician payment method preferred by many HMOs because it:
eliminates the FFS incentive to overutilize, costs are predictable, is less costly to administer.
How are outlier cases determined by a hospital?
Through the chargemaster
Blue Cross began as a physician service bureau in the 1930s.
False
The BBA of 1997 resulted in a major increase in HMO enrollment.
False
The Managed care backlash resulted in:
A reduction in HMO membership
New federal/state regulations
PPOs differ from HMOs because they do not accept capitation risk and enrollees who are
willing to pay higher cost sharing may access providers that are not in the contracted
network.
True
Health care cost inflation has remained consistent since 1995.
False
Managed care plans perform onsite reviews of hospitals and ambulatory surgical centers.
False
Hospital consolidation has been blocked more often than not by the DOJ and/or the FTC.
False
The same methodology used to pay a hospital for inpatient care is usually also used to pay
for outpatient care.
, False
Fee-for-service payment is the most common method used by HMOs to pay specialists.
True
In markets with high levels of managed care penetration, hospitals are usually paid using
a sliding scare discount on charges method.
False
What forms of hospital payment contain no elements of risk sharing by the hospital?
Sliding Scale FFS
What are the basic ways to compensate open-panel PCPs?
Capitation & FFS
Consolidation in the payer industry has resulted in most hospitals being unable to
obtain adequate rate increases.
False
What term refers to an all-inclusive rate paid by the HMO for both institutional
and professional services?
Bundled Payment
Payment to a facility for outpatient procedures may be increased on a case-by-case basis
through:
Carve-outs
Capitation is a physician payment method preferred by many HMOs because it:
eliminates the FFS incentive to overutilize, costs are predictable, is less costly to administer.
How are outlier cases determined by a hospital?
Through the chargemaster
