American Public University HIMA 240 Quiz 3 Results, Answered, Spring 2025/2026.

Attempt Score 27 / 30 - 90 % Overall Grade (Highest Attempt) 27 / 30 - 90 % Question 1 1 / 1 point All of the following services are typically reviewed for medical necessity and utilization except: Question options: Rehabilitative therapies Inpatient admissions Well-baby check Mental health and chemical dependency care Question 2 1 / 1 point Which government-sponsored program replaced the Aid to Families with Dependent Children (AFDC) program in 1996? Question options: Temporary Assistance for Needy Families program (TANF) State Children's Health Insurance Program (SCHIP) Programs of All-Inclusive Care for the Elderly (PACE) Medicare Part C Question 3 1 / 1 point The patient belonged to a managed care plan. The patient had an elective surgery. Prior approval for the elective surgery had not been obtained. What should the patient expect? Question options: Delay in scheduling the post-operative visit Reduction in future coverage of surgical services Denial of reimbursement for the surgeryIncrease in premium for next enrollment period Question 4 1 / 1 point All of the following are characteristics of managed care organizations except: Question options: Coordination of care across the continuum Integration of financing and delivery of health Management of costs and outcomes Freedom of choice and autonomous decision making Question 5 1 / 1 point All of the following are characteristics of disease management except: Question options: Prevention of exacerbations of chronic disease Promotion of healthy life choices Focus on single specialist for acute disease Monitoring of adherence to treatment plans Question 6 1 / 1 point What is the term for contracts that separate certain types of healthcare services to decrease MCOs' risk? Question options: Cherry picking Subcapitation Carve out Withhold poolQuestion 7 1 / 1 point All of the following are tools managed care organizations use to promote quality care in their healthcare plans except: Question options: Emphasis on health of populations Maintenance of accreditation Discernment in selection of providers Incentive to meet fiscal targets Question 8 1 / 1 point This program, formerly CHAMPUS (Civilian Health and Medical Program - Uniformed Services), provides coverage for the dependents of active members of the armed forces. Question options: TRICARE CHAMPVA Indian Health Service Worker's Compensation Question 9 1 / 1 point In which type of HMO are the physicians employees? Question options: Group model Independent practice association (IPA) model Staff model Network modelQuestion 10 1 / 1 point Which of the following services is most likely to be considered medically necessary? Question options: Caregivers' convenience or relief Cosmetic improvement Investigational cancer prevention Standard of care for health condition Question 11 1 / 1 point For which one of the following healthcare services is the managed care plan least likely to require a second opinion? Question options: Procedures that are high cost Conditions for which the diagnostic evidence is equivocal Treatment protocols that have low risk Treatments for which experts' opinions differ on efficacy Question 12 0 / 1 point All of the following are true of state Medicaid programs except: Question options: Federal funds allocated to each state are based on the average income per person for that state. The program must cover infants born to Medicaid-eligible pregnant women. States may offer a managed care option. Services offered to beneficiaries are the same in each state. Question 1 / 113 point Which of the following is not a function of the Indian Health Service (IHS)? Question options: Assists Indian tribes in the development of their own health programs Facilitates and assists Indian tribes in coordinating health planning Provides only inpatient healthcare services Promotes using health resources available at federal, state, and local levels Question 14 1 / 1 point The patient belonged to a managed care plan. Prior approval for the surgery was received. What number should the insurance analyst record? Question options: Social security Drug enforcement administration Credit score Precertification Question 15 1 / 1 point The Medicare Program is divided into _____ parts. Question options: 2 3 4 5 Question 16 1 / 1 pointWhat is the term for an explicit statement that directs clinical decision making? Question options: Cookbook medicine Preauthorization Evidence-based practice guideline Withhold pool Question 17 1 / 1 point Which TRICARE program offers services to active duty family members(ADFMs) with no enrollment, deductible, or copayment fees for covered services? Question options: TRICARE Prime TRICARE Standard TRICARE for Life All of the above Question 18 0 / 1 point All of the following sets represent criteria for medical necessity and utilization review except: Question options: Intensity of Service, Severity of Illness, and Discharge Screens Appropriateness Evaluation Protocol Milliman and Robertson Guidelines Federal Register Index and Ratings Question 19 1 / 1 point For what type of care should the physician practice manager expect to work with a case manager?Question options: Well-baby check Pre-athletics exam Acute appendicitis Workers' compensation Question 20 1 / 1 point Why did Congress pass the Health Maintenance Organization Act of 1973? Question options: To encourage the delivery of affordable, quality healthcare To increase the number of physicians in primary care To deter the privatization of the Blue Cross plans To standardize the costs of healthcare across the nation Question 21 1 / 1 point All of the following are purposes of the surveys that managed care organizations send their patient/members except: Question options: Reasons for referral to specialists Perceptions of the plans' strengths and weaknesses Suggestions for improvements Intentions regarding reenrollment Question 22 0 / 1 point Which of the following is/are true of CHIP? Question options:It is a federal/state program It is a state/local program It varies from state to state A and C are true. B and C are true. Question 23 1 / 1 point All of the following attributes characterize episode-of-care reimbursement except: Question options: Capitation Global payment Retrospective fee-for-service Aggregation of utilization of healthy members and chronically ill members Question 24 1 / 1 point The Civilian Health and Medical Program of the Department of Veterans Affairs(CHAMPVA) is available for: Question options: Veterans of the armed forces Spouse or widow(er) of a veteran meeting specific criteria Children of a veteran meeting specific criteria Any spouse, widow(er) or children of a veteran B and C Question 25 1 / 1 point All of the following are elements of prescription management except:Question options: Links to electronic banking Formulary Patient education Alerts for interactions Question 26 1 / 1 point What is the term that means evaluating, for a healthcare service, the appropriateness of its setting and its level of service? Question options: Coordination of service benefits Community rating Outcomes assessment Utilization review Question 27 1 / 1 point Today's managed care traces its origins to all of the following arrangements except: Question options: 1800, Congress awarding pensions for US naval personnel on the basis of death or disability during active service 1910, Western Clinic of Tacoma, Washington offering its members medical services for $0.50 per month 1929, Blue Cross of Dallas, Texas establishing schoolteachers' plan of 21 days of hospitalization for $6 per year 1930s, Kaiser Construction setting up health plan for its workers Question 28 1 / 1 point Gatekeepers determine the appropriateness of all of the following components except: Question options:Rate of capitation or reimbursement Healthcare service itself Level of healthcare personnel Setting in the continuum of care Question 29 1 / 1 point Medicare part C is a ___________ option known as Medicare Advantage. Question options: Managed care Fee for service Self-insured Free Question 30 1 / 1 point Which Part of the Medicare program was created under the Medicare Modernization Act of 2003 (MMA)? Question options: Part A Part B Part C Part D