HSA4109 Final Exam Questions with Correct
Answers
Which of the following certificate is the state-issued operating license for an HMO
certificate of authority (COA)
Who has final responsibility for all aspects of an independent HMO ?
board of directors
Beginning in 2014, what new distribution channel became available
state-level health insurance exchanges
Why is budgeting with in the financial department of the MCO so important
all of the above
-must determine the bottom line....
The DHHS designates the responsibility for the development, maintenance, and
modifications of electronic data interchange standards to which type of organization
DMSO's
Dual eligible Special needs plan in roll individuals who are "dual eligible" who are the
"dual eligible"
individuals who are eligible for medicare and medicaid
Which of the following formulas has been adopted by an NAIC to determine how much the
capital requirements are for a particular managed care plan
, risk based capital (RBC)
Which of the following are not typically considered to be marketing functions
closing the sale
Part D of Medicare that added drug coverage as a benefit was created by which set ?
medicare modernization act (MMA)
medical directions typically have responsibility for
a, b, and c
-utilization management, benefits determinations for appeals, quality management
Which of the following major distribution channels are required to be licensed by states?
both a and b
-brokers and agents
What is the first function performed by the claims department
claim capture
Which of the following electronic transaction does HIPAA not standardized
electronic medical records
Which part of Medicare is not a benefit, but more so a provision for beneficiaries to receive
Medicare benefits through and approved private plan
Part C
Answers
Which of the following certificate is the state-issued operating license for an HMO
certificate of authority (COA)
Who has final responsibility for all aspects of an independent HMO ?
board of directors
Beginning in 2014, what new distribution channel became available
state-level health insurance exchanges
Why is budgeting with in the financial department of the MCO so important
all of the above
-must determine the bottom line....
The DHHS designates the responsibility for the development, maintenance, and
modifications of electronic data interchange standards to which type of organization
DMSO's
Dual eligible Special needs plan in roll individuals who are "dual eligible" who are the
"dual eligible"
individuals who are eligible for medicare and medicaid
Which of the following formulas has been adopted by an NAIC to determine how much the
capital requirements are for a particular managed care plan
, risk based capital (RBC)
Which of the following are not typically considered to be marketing functions
closing the sale
Part D of Medicare that added drug coverage as a benefit was created by which set ?
medicare modernization act (MMA)
medical directions typically have responsibility for
a, b, and c
-utilization management, benefits determinations for appeals, quality management
Which of the following major distribution channels are required to be licensed by states?
both a and b
-brokers and agents
What is the first function performed by the claims department
claim capture
Which of the following electronic transaction does HIPAA not standardized
electronic medical records
Which part of Medicare is not a benefit, but more so a provision for beneficiaries to receive
Medicare benefits through and approved private plan
Part C
