HOM 5307 Questions and Correct Verified Answers
Blue cross began as a physician service bureau in the 1930s.
false, began as hospital only. Blue shield was the physician review
The HIPDB is a national health care fraud and abuse data collection program for the
reporting and disclosure of certain final adverse actions taken against health care providers,
suppliers, or practioners
true
The Balance Budget Act (BBA) pf 1997 resulted in a major increase in enrollment
false
Considerations for successful network development include geographic accessibility and
hospital related needs
true
Health care costs inflation has remained consistent since 1995
false
physicians avoid working for hospitals as much as possible
false
CH 2: HMOs are licensed as health insurance companies
False, licensed under a certificate of authority
, An IPA is an HMO that contracts directly with physicians and hospitals
false
Managed care plans perform onsite reviews of hospitals and ambulatory surgical centers
false, are not onsite but do the reviews
The defining feature of a direct contract model is the HMO contracting directly with a
hospital to provide acute services to its members
False
the defining feature of a direct contract model is Independent practice association (IPA) Open
panel HMOis
CH5: in markets with high levels of managed care penetration, hospitals are usually
paid using a sliding scale discount on charges method
false
An IDS can be described as a legal entity consisting of more than one type of provider
to manage a populations health care and/or contract with a payer organization
True
IDS is a investigative delivery system
Hospital consolidation has been blocked more often than not by the Department of
Justice (DOJ) and/or the Federal Trade Commission (FTC)
false
Key common characteristics of PPOs include:
Select provider panels
Negotiated payment rates
Consumer choice
Utilization management
Blue cross began as a physician service bureau in the 1930s.
false, began as hospital only. Blue shield was the physician review
The HIPDB is a national health care fraud and abuse data collection program for the
reporting and disclosure of certain final adverse actions taken against health care providers,
suppliers, or practioners
true
The Balance Budget Act (BBA) pf 1997 resulted in a major increase in enrollment
false
Considerations for successful network development include geographic accessibility and
hospital related needs
true
Health care costs inflation has remained consistent since 1995
false
physicians avoid working for hospitals as much as possible
false
CH 2: HMOs are licensed as health insurance companies
False, licensed under a certificate of authority
, An IPA is an HMO that contracts directly with physicians and hospitals
false
Managed care plans perform onsite reviews of hospitals and ambulatory surgical centers
false, are not onsite but do the reviews
The defining feature of a direct contract model is the HMO contracting directly with a
hospital to provide acute services to its members
False
the defining feature of a direct contract model is Independent practice association (IPA) Open
panel HMOis
CH5: in markets with high levels of managed care penetration, hospitals are usually
paid using a sliding scale discount on charges method
false
An IDS can be described as a legal entity consisting of more than one type of provider
to manage a populations health care and/or contract with a payer organization
True
IDS is a investigative delivery system
Hospital consolidation has been blocked more often than not by the Department of
Justice (DOJ) and/or the Federal Trade Commission (FTC)
false
Key common characteristics of PPOs include:
Select provider panels
Negotiated payment rates
Consumer choice
Utilization management
