AAPC – CPB – CHAPTER 2 REVIEW EXAM – FULL QUESTIONS AND ANSWERS –
QUESTIONS 1 TO 25
QUESTION# 1
What is an insurance plan that provides a gatekeeper to manage the
patient’s healthcare?
A. PPO
B. Correct: HMO
C. IPO
D. Medicaid
Feedback: Rationale: A gatekeeper or PCP is provided to manage the
patient’s healthcare needs.
QUESTION# 2
What are some of the ways that managed care organizations (MCOs) offer
provisions that provide insurers with ways to manage the cost, use, and
quality of healthcare services received by a member?
I. Utilization review
II. Coverage restrictions
III. Arbitration
IV. Non-emergency weekend admission restrictions
A. Correct: I, IV
B. I, II, IV
C. II, III, IV
D. II, IV
Feedback: Rationale: Managed care organizations offer managed care
provisions that provide insurers with ways to manage the cost, use, and
quality of healthcare services received by group members, including:
Utilization review, non-emergency weekend admission restrictions,
preadmission certification, preadmission testing, and second surgical
opinions.
, QUESTION# 3
Which option is not considered an MCO?
A. Exclusive Provider Organizations (EPOs)
B. Health Maintenance Organizations (HMOs)
C. Preferred Provider Organizations (PPOs)
D. Correct: Health Savings Account (HSA)
Feedback: Rationale: MCOs include Exclusive Provider Organizations (EPOs),
Health Maintenance Organizations (HMOs), Integrated Delivery Systems
(IDSs), Preferred Provider Organizations (PPOs), and Triple Option Plans.
QUESTION# 4
ACOs are similar to HMOs in that they have shared risks. They do have
differences. Which statement is TRUE?
A. ACOs require a five-year commitment
B. Both HMOs and ACOs function as an insurance company.
C. Correct: The ACO is formed with only 5,000 beneficiaries instead of
HMOs that generally have hundreds of thousands of beneficiaries.
D. ACO’s are performance based while HMOs are not
Feedback: Rationale: CMS has established that an ACO is responsible for only
5,000 beneficiaries and requires a minimum of a three-year commitment.
ACOs do not function as insurance companies.
QUESTION# 5
What type of plan allows an insurer to administer straight indemnity
insurance, an HMO, or a PPO insurance plans to its members?
A. Correct: Triple option plan
B. Full option plan
C. Integrated provider plan
D. Management service organization
Feedback: Rationale: A triple option plan is usually operated by a single
insurance plan or a joint venture among two or more insurance payers. A
triple option plan allows an insurer to administer three different healthcare
QUESTIONS 1 TO 25
QUESTION# 1
What is an insurance plan that provides a gatekeeper to manage the
patient’s healthcare?
A. PPO
B. Correct: HMO
C. IPO
D. Medicaid
Feedback: Rationale: A gatekeeper or PCP is provided to manage the
patient’s healthcare needs.
QUESTION# 2
What are some of the ways that managed care organizations (MCOs) offer
provisions that provide insurers with ways to manage the cost, use, and
quality of healthcare services received by a member?
I. Utilization review
II. Coverage restrictions
III. Arbitration
IV. Non-emergency weekend admission restrictions
A. Correct: I, IV
B. I, II, IV
C. II, III, IV
D. II, IV
Feedback: Rationale: Managed care organizations offer managed care
provisions that provide insurers with ways to manage the cost, use, and
quality of healthcare services received by group members, including:
Utilization review, non-emergency weekend admission restrictions,
preadmission certification, preadmission testing, and second surgical
opinions.
, QUESTION# 3
Which option is not considered an MCO?
A. Exclusive Provider Organizations (EPOs)
B. Health Maintenance Organizations (HMOs)
C. Preferred Provider Organizations (PPOs)
D. Correct: Health Savings Account (HSA)
Feedback: Rationale: MCOs include Exclusive Provider Organizations (EPOs),
Health Maintenance Organizations (HMOs), Integrated Delivery Systems
(IDSs), Preferred Provider Organizations (PPOs), and Triple Option Plans.
QUESTION# 4
ACOs are similar to HMOs in that they have shared risks. They do have
differences. Which statement is TRUE?
A. ACOs require a five-year commitment
B. Both HMOs and ACOs function as an insurance company.
C. Correct: The ACO is formed with only 5,000 beneficiaries instead of
HMOs that generally have hundreds of thousands of beneficiaries.
D. ACO’s are performance based while HMOs are not
Feedback: Rationale: CMS has established that an ACO is responsible for only
5,000 beneficiaries and requires a minimum of a three-year commitment.
ACOs do not function as insurance companies.
QUESTION# 5
What type of plan allows an insurer to administer straight indemnity
insurance, an HMO, or a PPO insurance plans to its members?
A. Correct: Triple option plan
B. Full option plan
C. Integrated provider plan
D. Management service organization
Feedback: Rationale: A triple option plan is usually operated by a single
insurance plan or a joint venture among two or more insurance payers. A
triple option plan allows an insurer to administer three different healthcare
