HIMA 240 Quiz 2| Questions and Answers Latest Updated 2026/2027 (Graded A+)-
American Public University
Question 1 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 2 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 pool
Question 3 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 4 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 5 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 6 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 7 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 8 point
Access to mental or behavioral health or medical specialists is through referral. What is the term for the
individual who makes the referral?
Question options:
Primary care provider
Gatekeeper
Primary care physician
All of the above
Question 9 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
American Public University
Question 1 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 2 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 pool
Question 3 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 4 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 5 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 6 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 7 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 8 point
Access to mental or behavioral health or medical specialists is through referral. What is the term for the
individual who makes the referral?
Question options:
Primary care provider
Gatekeeper
Primary care physician
All of the above
Question 9 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
