HOM 5307 Exam 4 Questions and Correct
Verified Answers
Consolidation in the payer industry has resulted in most hospitals being unable to obtain
adequate rate increases.
T or F
False
Which organization(s) need a Corporate Compliance Officer (CCO)?
Hospitals
Health plans with a Medicare Advantage risk contract
Every organization that provides health care
Hospitals and Health plans with a Medicare Advantage risk contract
Health Plan Employer Data and Information Set is the less widely used set of measures
for reporting on managed behavioral health care. T or F
False
The following term refers to an all-inclusive rate paid by the HMO for both institutional and
professional services:
Bundled payment
Per diem
,Case rate
Straight DRGs
Bundled payment
The original impetus of HMOs development came from:
Providers seeking patient revenues
Insurance companies
Consumers seeking access to health care
A & C Only
Providers seeking patient revenues and Consumers seeking access to health care
HMOs are licensed as health insurance companies.
True
False
false
Common sources of information that trigger DM include:
Claims
Pharmacy data
Laboratory tests
A & b oNLY
Claims and pharmacy
The GPWW requires the participation of a hospital and the formation of a group practice.
True
False
False
An IDS can be described as a legal entity consisting of more than one type of provider
to manage a population's health care and/or contract with a payer organization.
, True
False
True
Claims review is an example of
Concurrent review
Discharge planning
Prospective review
Retrospective review
Retrospective review
UM focuses on telling doctors and hospitals what to do.
True
False
False
The same methodology used to pay a hospital for inpatient care is usually also use to pay for
outpatient care.
True
False
False
Electronic prescribing offers which of the following potential outcomes?
Improvement in physician drug formulary prescribing conformance
Verified Answers
Consolidation in the payer industry has resulted in most hospitals being unable to obtain
adequate rate increases.
T or F
False
Which organization(s) need a Corporate Compliance Officer (CCO)?
Hospitals
Health plans with a Medicare Advantage risk contract
Every organization that provides health care
Hospitals and Health plans with a Medicare Advantage risk contract
Health Plan Employer Data and Information Set is the less widely used set of measures
for reporting on managed behavioral health care. T or F
False
The following term refers to an all-inclusive rate paid by the HMO for both institutional and
professional services:
Bundled payment
Per diem
,Case rate
Straight DRGs
Bundled payment
The original impetus of HMOs development came from:
Providers seeking patient revenues
Insurance companies
Consumers seeking access to health care
A & C Only
Providers seeking patient revenues and Consumers seeking access to health care
HMOs are licensed as health insurance companies.
True
False
false
Common sources of information that trigger DM include:
Claims
Pharmacy data
Laboratory tests
A & b oNLY
Claims and pharmacy
The GPWW requires the participation of a hospital and the formation of a group practice.
True
False
False
An IDS can be described as a legal entity consisting of more than one type of provider
to manage a population's health care and/or contract with a payer organization.
, True
False
True
Claims review is an example of
Concurrent review
Discharge planning
Prospective review
Retrospective review
Retrospective review
UM focuses on telling doctors and hospitals what to do.
True
False
False
The same methodology used to pay a hospital for inpatient care is usually also use to pay for
outpatient care.
True
False
False
Electronic prescribing offers which of the following potential outcomes?
Improvement in physician drug formulary prescribing conformance
