HOM 5307 #2 Exam Questions and Answers Solved Correctly Rated A+
Technique is used by many pharmaceutical companies with health plans and PBMs to increase formulary
access and utilization of specific products: - Answers Rebates for preferred formulary position
Health economic data, including a growing number of head-to-head clinical trials
Member copayment coupons to offset copayments
Recent legislation encourages separate lifetime limits for limits for behavioral care (T/F) - Answers False
The majority of prescriptions for behavioral health medications are written by non psychiatrist. (T/F) -
Answers True
Physicians treating gynecological patients diagnose substance abuse approximately 30% of the time.
(T/F) - Answers False
Approximately 50% of behavioral care spending is associated with what percentage of patients? -
Answers 5%
Which organization does not accredit managed behavioral health care companies? - Answers American
College of Mental Health Administration
Behavioral health care providers are paid under methodologies similar to those applied to
medical/surgical care providers. (T/F) - Answers True
Pay for performance (P4P) cannot be applied to behavioral health care providers. (T/F) - Answers False
HEDIS is the most widely used set of measures for reporting on managed behavioral health care. (T/F) -
Answers True
What entities must document quality improvement processes in order to gain URAC accreditation -
Answers Credentials verification
Organizations
Health websites
Health plans
, What organization typically accredited by the (Accreditation Association of Ambulatory Health Care)
AAAHC? - Answers Clinic
Dental Office
What organizations have developed accreditation programs for managed care organizations - Answers
NCQA
URAC
AAAHC
The Healthcare Effectiveness Data and Information Set (HEDIS) is a measurement tool used by
about______ of all health plans - Answers 90%
All managed care plans are required by the federal government to participate in accreditation and
performance measurement programs. (T/F) - Answers False
All accredited health plans are required to report on their clinical performance though HEDIS. (T/F) -
Answers False
______is a set of standardized measures that look at plan performance across a variety of important
dimensions, such as delivery of preventive health services, member satisfaction, and treatment efficacy
for various illnesses - Answers HEDIS
The utilization management processes of plans seeking URAC accreditation must be: - Answers
Performed by licensed clinical professionals
Based on up to date clinical principles
To earn NCQA accreditation, an organization must meet_______standards designed to ensure that this
key health plan function promotes good medicine rather than acting as an arbitrary barrier to care. -
Answers Utilization Management
The first and most rigorous area of NCQA review is - Answers a health plan's own internal quality control
system
What two significant developments that have direct impact on the claims capability: - Answers
Transition from ICD-9 to ICD-10 diagnosis and procedure codes
Technique is used by many pharmaceutical companies with health plans and PBMs to increase formulary
access and utilization of specific products: - Answers Rebates for preferred formulary position
Health economic data, including a growing number of head-to-head clinical trials
Member copayment coupons to offset copayments
Recent legislation encourages separate lifetime limits for limits for behavioral care (T/F) - Answers False
The majority of prescriptions for behavioral health medications are written by non psychiatrist. (T/F) -
Answers True
Physicians treating gynecological patients diagnose substance abuse approximately 30% of the time.
(T/F) - Answers False
Approximately 50% of behavioral care spending is associated with what percentage of patients? -
Answers 5%
Which organization does not accredit managed behavioral health care companies? - Answers American
College of Mental Health Administration
Behavioral health care providers are paid under methodologies similar to those applied to
medical/surgical care providers. (T/F) - Answers True
Pay for performance (P4P) cannot be applied to behavioral health care providers. (T/F) - Answers False
HEDIS is the most widely used set of measures for reporting on managed behavioral health care. (T/F) -
Answers True
What entities must document quality improvement processes in order to gain URAC accreditation -
Answers Credentials verification
Organizations
Health websites
Health plans
, What organization typically accredited by the (Accreditation Association of Ambulatory Health Care)
AAAHC? - Answers Clinic
Dental Office
What organizations have developed accreditation programs for managed care organizations - Answers
NCQA
URAC
AAAHC
The Healthcare Effectiveness Data and Information Set (HEDIS) is a measurement tool used by
about______ of all health plans - Answers 90%
All managed care plans are required by the federal government to participate in accreditation and
performance measurement programs. (T/F) - Answers False
All accredited health plans are required to report on their clinical performance though HEDIS. (T/F) -
Answers False
______is a set of standardized measures that look at plan performance across a variety of important
dimensions, such as delivery of preventive health services, member satisfaction, and treatment efficacy
for various illnesses - Answers HEDIS
The utilization management processes of plans seeking URAC accreditation must be: - Answers
Performed by licensed clinical professionals
Based on up to date clinical principles
To earn NCQA accreditation, an organization must meet_______standards designed to ensure that this
key health plan function promotes good medicine rather than acting as an arbitrary barrier to care. -
Answers Utilization Management
The first and most rigorous area of NCQA review is - Answers a health plan's own internal quality control
system
What two significant developments that have direct impact on the claims capability: - Answers
Transition from ICD-9 to ICD-10 diagnosis and procedure codes
