HOM 5307 Exam 2 Set 2 Questions and Answers Solved Correctly Rated A+
A set of causes and conditions that come together in a series of steps to transfer inputs into outcomes is
called - Answers Structure
T or F: It is important for all CSRs to be able to address all aspects of plan operations. - Answers False
T or F: Providers, employers, agents, and members expect many health plan services to be available
online. The preferred approach to allow access is through web-portals and interactive voice response
systems. - Answers True
T or F: All accredited health plans are required to report on their clinical performance through HEDIS. -
Answers False
To earn NCQA accreditation, an organization must meet rigorous _________ 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
Member services are responsible for - Answers -providing information to members
-helping members with any problems
-handling member grievances and complaints
-tracking and reporting patterns of problems encountered
-enhancing the relationship between the members of the plan and the plan itself
T or F: ERISA preempts all state laws. - Answers False
The best data source for any health plan is ______ because it implicitly recognizes all the plan-specific
characteristics. - Answers Experience
T or F: Practice guidelines that can be repeated over and over again with the same result are always
considered to be valid. - Answers False
T or F: While the federal government requires Medicare plans to submit performance data, most
participation in such programs is voluntary. - Answers False
T or F: The most common form of claims submissions is electronic. - Answers True
_______ is the term for the rate at which medical services are used. - Answers Utilization
T or F: ERISA requires expedited review for claims involving urgent care. - Answers True
T or F: Donabedian's criteria for assessing quality of care are no longer relevant. - Answers False
A set of causes and conditions that come together in a series of steps to transfer inputs into outcomes is
called - Answers Structure
T or F: It is important for all CSRs to be able to address all aspects of plan operations. - Answers False
T or F: Providers, employers, agents, and members expect many health plan services to be available
online. The preferred approach to allow access is through web-portals and interactive voice response
systems. - Answers True
T or F: All accredited health plans are required to report on their clinical performance through HEDIS. -
Answers False
To earn NCQA accreditation, an organization must meet rigorous _________ 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
Member services are responsible for - Answers -providing information to members
-helping members with any problems
-handling member grievances and complaints
-tracking and reporting patterns of problems encountered
-enhancing the relationship between the members of the plan and the plan itself
T or F: ERISA preempts all state laws. - Answers False
The best data source for any health plan is ______ because it implicitly recognizes all the plan-specific
characteristics. - Answers Experience
T or F: Practice guidelines that can be repeated over and over again with the same result are always
considered to be valid. - Answers False
T or F: While the federal government requires Medicare plans to submit performance data, most
participation in such programs is voluntary. - Answers False
T or F: The most common form of claims submissions is electronic. - Answers True
_______ is the term for the rate at which medical services are used. - Answers Utilization
T or F: ERISA requires expedited review for claims involving urgent care. - Answers True
T or F: Donabedian's criteria for assessing quality of care are no longer relevant. - Answers False
