HSA 4109 Exam 2 Chapter 4 - 5 Exam Review
Questions with Verified Correct Answers
Most common measurement of inpatient utilization
bed days per thousand enrollees
Which form of hospital payment contains no elements of risk sharing by the hospital
sliding scale FFS Fee-For-Service
The same method used to pay a hospital for inpatient care is usually also used to pay for
outpatient care
FALSE
UM Utilization Management focuses on telling doctors and hospitals what to do
FALSE
Pay for Performance refers to financial incentives aligned with the practice of evidence based
clinical care and is based on incentives rather than risk based
TRUE
In an OPEN FORMULARY, there is no cover under most conditions for drugs not included in
the formulary
FALSE
Under ACA, the first dollar coverage of preventive services is NOT mandatory, meaning that
cost sharing is allowed when such service is provided by network providers
FALSE
FFS Fee-For-Service is the most common payment method by HMOs to pay SPECIALISTS
TRUE
Fee-for-service is the most predominant method of physician reimbursement in the closed
panel plans
FALSE
, Who calls the MCO for authorization depends on the type and structure of the health benefit
plan
FALSE
in a contract between a hospital and a managed care plan that contains payment provisions
related outliers cases, what are those cases typically based upon
hospital's charge master
Hospital utilization varies by geographical area
TRUE
All managed care plans are required by the federal government to participate in accreditation
and performance measurement programs
FALSE
Capitation usually defined as
prepayment for services on a fixed, per member per month basis
What refers to an all inclusive rate paid by the HMO for both institutional and professional
services
BUNDLED PAYMENT
Methods used to manage ancillary service
ALL:
set limitations
monitor physician behavior
contracting on a favorable basis
set standard of care
in markets with high levels of managed care penetration, hospitals are usually paid using a
sliding scale discount on charges method
FALSE
Nurse-on-call or medical advice programs are considered demand management strategies
TRUE
Utilization management seeks to reduce practice variation while promoting good outcomes
and
Questions with Verified Correct Answers
Most common measurement of inpatient utilization
bed days per thousand enrollees
Which form of hospital payment contains no elements of risk sharing by the hospital
sliding scale FFS Fee-For-Service
The same method used to pay a hospital for inpatient care is usually also used to pay for
outpatient care
FALSE
UM Utilization Management focuses on telling doctors and hospitals what to do
FALSE
Pay for Performance refers to financial incentives aligned with the practice of evidence based
clinical care and is based on incentives rather than risk based
TRUE
In an OPEN FORMULARY, there is no cover under most conditions for drugs not included in
the formulary
FALSE
Under ACA, the first dollar coverage of preventive services is NOT mandatory, meaning that
cost sharing is allowed when such service is provided by network providers
FALSE
FFS Fee-For-Service is the most common payment method by HMOs to pay SPECIALISTS
TRUE
Fee-for-service is the most predominant method of physician reimbursement in the closed
panel plans
FALSE
, Who calls the MCO for authorization depends on the type and structure of the health benefit
plan
FALSE
in a contract between a hospital and a managed care plan that contains payment provisions
related outliers cases, what are those cases typically based upon
hospital's charge master
Hospital utilization varies by geographical area
TRUE
All managed care plans are required by the federal government to participate in accreditation
and performance measurement programs
FALSE
Capitation usually defined as
prepayment for services on a fixed, per member per month basis
What refers to an all inclusive rate paid by the HMO for both institutional and professional
services
BUNDLED PAYMENT
Methods used to manage ancillary service
ALL:
set limitations
monitor physician behavior
contracting on a favorable basis
set standard of care
in markets with high levels of managed care penetration, hospitals are usually paid using a
sliding scale discount on charges method
FALSE
Nurse-on-call or medical advice programs are considered demand management strategies
TRUE
Utilization management seeks to reduce practice variation while promoting good outcomes
and
