CEBS GBA 2 PRACTICE EXAM
QUESTIONS WITH COMPLETE
SOLUTIONS GRADED A+
1 of 100
Term
Which of the following statements regarding health insurance rating
systems is (are) correct?
I. Both prospective and retrospective experience rating use an
employer's experience to calculate the insurance rate.
II. With prospective rating, the insured, not the insurer, bears
the underwriting risk.
III. If experience in the year 20X1 is used to determine the rate for
the subsequent year, 20X2, this would be retrospective rating.
Give this one a try later!
, E.)I and III only D.) II and III only
A.) I only B.) II only
Don't know?
2 of 100
Term
All the following statements regarding the usual and customary rate
(UCR) used in health insurer reimbursement practices are correct
EXCEPT:
A.) An investigation by one large state alleged conflict of interest
between a major insurer and the entity responsible for managing
the database used to calculate UCR.
B.) An independent, nonprofit company has been
established to manage the database for computing UCR.
C.) More and more insurers are abandoning the traditional UCR pay
formulas.
D.)Changes involving the UCR have greatly decreased the amount
of balance billing.
E.) The use of the Medicare rate has increased recently.
Give this one a try later!
E.) Of the many successes of
the Diamond Project, much of it A.) TPA services provided to
has been with patients self- funded plans are highly
covered by uniform
, Medical Assistance fee-for-service among TPA firms.
insurance.
D.) Changes involving A.) The use of unisex rates, which
the UCR have greatly insurers would prefer, has
decreased the amount of been prohibited.
balance billing.
Don't know?
3 of 100
Term
Which of the following statements regarding health expenditures
and related research is correct?
A.) In general, risk adjustment models have been able to predict
about 80 percent of total claims.
B.) Age and gender account for about 90 percent of
explained variation in health care expenditures.
C.) Medicare currently pays Medicare Advantage plans on the basis
of the Centers for Medicare & Medicaid Services Hierarchical
Condition Categories (CMS-HCC) model, which uses approximately
70 clinical conditions.
D.)Health maintenance organizations (HMOs) that could predict
health expenditures only five percentage points better than
Medicare would not gain a significant amount of profit per enrollee.
E.)Inpatient expenditures are more predictable than
outpatient expenditures.
Give this one a try later!
, E.) Nearly all approaches utilize a blend of pay-for-performance, monthly per-
enrollee payments, and fee-for-service.
C.) Medicare currently pays Medicare Advantage plans on the basis of the
Centers for Medicare & Medicaid Services Hierarchical Condition
Categories (CMS-HCC) model, which uses approximately 70 clinical
conditions.
B.)Fears of not being able to change carriers due to the underwriting practice of
not accepting policyholders with an existing five-plus-years policy in force with
another carrier.
E.) I, II and III
Don't know?
4 of 100
Term
Which of the following statements regarding low-cost, retail health
care clinics is (are) correct?
I. While low-cost, retail health clinics offered the promise of lowering
the cost of health care, actual experience has been negative and the
number of these clinics has been declining.
II.This approach requires the onsite, day-to-day management of
a physician.
III.These clinics can offer a range of medical services from basic
triage and prevention to management of chronic conditions like
diabetes and heart disease.
QUESTIONS WITH COMPLETE
SOLUTIONS GRADED A+
1 of 100
Term
Which of the following statements regarding health insurance rating
systems is (are) correct?
I. Both prospective and retrospective experience rating use an
employer's experience to calculate the insurance rate.
II. With prospective rating, the insured, not the insurer, bears
the underwriting risk.
III. If experience in the year 20X1 is used to determine the rate for
the subsequent year, 20X2, this would be retrospective rating.
Give this one a try later!
, E.)I and III only D.) II and III only
A.) I only B.) II only
Don't know?
2 of 100
Term
All the following statements regarding the usual and customary rate
(UCR) used in health insurer reimbursement practices are correct
EXCEPT:
A.) An investigation by one large state alleged conflict of interest
between a major insurer and the entity responsible for managing
the database used to calculate UCR.
B.) An independent, nonprofit company has been
established to manage the database for computing UCR.
C.) More and more insurers are abandoning the traditional UCR pay
formulas.
D.)Changes involving the UCR have greatly decreased the amount
of balance billing.
E.) The use of the Medicare rate has increased recently.
Give this one a try later!
E.) Of the many successes of
the Diamond Project, much of it A.) TPA services provided to
has been with patients self- funded plans are highly
covered by uniform
, Medical Assistance fee-for-service among TPA firms.
insurance.
D.) Changes involving A.) The use of unisex rates, which
the UCR have greatly insurers would prefer, has
decreased the amount of been prohibited.
balance billing.
Don't know?
3 of 100
Term
Which of the following statements regarding health expenditures
and related research is correct?
A.) In general, risk adjustment models have been able to predict
about 80 percent of total claims.
B.) Age and gender account for about 90 percent of
explained variation in health care expenditures.
C.) Medicare currently pays Medicare Advantage plans on the basis
of the Centers for Medicare & Medicaid Services Hierarchical
Condition Categories (CMS-HCC) model, which uses approximately
70 clinical conditions.
D.)Health maintenance organizations (HMOs) that could predict
health expenditures only five percentage points better than
Medicare would not gain a significant amount of profit per enrollee.
E.)Inpatient expenditures are more predictable than
outpatient expenditures.
Give this one a try later!
, E.) Nearly all approaches utilize a blend of pay-for-performance, monthly per-
enrollee payments, and fee-for-service.
C.) Medicare currently pays Medicare Advantage plans on the basis of the
Centers for Medicare & Medicaid Services Hierarchical Condition
Categories (CMS-HCC) model, which uses approximately 70 clinical
conditions.
B.)Fears of not being able to change carriers due to the underwriting practice of
not accepting policyholders with an existing five-plus-years policy in force with
another carrier.
E.) I, II and III
Don't know?
4 of 100
Term
Which of the following statements regarding low-cost, retail health
care clinics is (are) correct?
I. While low-cost, retail health clinics offered the promise of lowering
the cost of health care, actual experience has been negative and the
number of these clinics has been declining.
II.This approach requires the onsite, day-to-day management of
a physician.
III.These clinics can offer a range of medical services from basic
triage and prevention to management of chronic conditions like
diabetes and heart disease.
