HSA4109 ALL TEST QUESTIONS WITH SOLUTIONS 2025
GRADED A+
✔✔For a state to use managed care for Medicaid beneficiaries, it must obtain which of
the following? - ✔✔Section 1115 Waiver
✔✔State oversight of MCO focuses on what? - ✔✔how managed care is provided, what
MCOs can and cannot do in carrying out their business operations
✔✔Which of the following electronic transactions does HIPAA not standardize? -
✔✔Electronic medical records
✔✔Which accreditation organization account for nearly all health plan accreditations? -
✔✔NCQA, URAC
✔✔Medical Directors typically have responsibility for what? - ✔✔utilization
management, benefits determinations for appeals, quality management
✔✔What are the special requirements for Medicare Advantage Plans? - ✔✔external
review, access standards, member appeals, enrollment
✔✔Beginning in 2014, what new distribution channel became available? - ✔✔State-
level health insurance exchanges
✔✔This rating entails the application of a standard rate to all groups within the
community being underwritten. - ✔✔Basic community rating
✔✔A set of rules and definitions that provide for uniform financial reporting in
accounting practices is? - ✔✔GAAP
✔✔T/F The Finance Director, not the Marketing Director, has responsibility for
enrollment forecasting. - ✔✔False
✔✔T/F Central to the privacy and security regulations is the concept of protected health
information. - ✔✔True
✔✔T/F States regulate all employer-sponsored health benefit plans. - ✔✔False
✔✔T/F In many states, premium taxes are the first largest source of state revenue over
individual and business income taxes. - ✔✔False
✔✔A high rate of member turnover is known as? - ✔✔churning
, ✔✔T/F All MCOs use a contracted provider network to deliver care to the plan's
enrollees. - ✔✔True
✔✔T/F Accreditation may be voluntary, but most states accept accreditation as meeting
the state's standard in the functional areas addressed by accreditation. - ✔✔True
✔✔Which part of Medicare is funded by pay-rollers tax deposits into hospital funds? -
✔✔Part A
Side note: Part C is not a benefit; private insurers
Part D is medication
✔✔T/F Most but not all MCO's have a board of directors - ✔✔True
✔✔T/F All states require PPOs to be accredited - ✔✔False
HMOs are required; Some PPOs can be accredited but they are not required
✔✔This form of accounting is based on the actual movement of cash, such as currency,
deposits, bill payments, etc. - ✔✔cash accounting
✔✔T/F States have the authority to examine the accounting and financial records of
MCOs and take action if their statutory surplus levels fall too low. - ✔✔True
✔✔What are the basic aspects of HIPAAs administrative simplifications? - ✔✔national
provider identifier, privacy of medical information, transactions and code sets, security
of medical information
✔✔T/F To be eligible to join a Part C plan, beneficiaries have to already had Medicare
Part A and B - ✔✔True
✔✔T/F A participating provider is permitted to balance bill a member for any amount not
paid due to the application of a fee schedule or other provider payment mechanism -
✔✔False
✔✔What is represented as the backbone of the MCOs operations? - ✔✔information
systems
✔✔Which of the following is not a measure in the Medicare Quality Bonus Program (i.e.
the "Stars" program) for Medicare Advantage plans: - ✔✔Reducing costs
✔✔Refers to the day-to-day functions of the finance department such tracking all money
that comes in and goes out. - ✔✔Operational finance
GRADED A+
✔✔For a state to use managed care for Medicaid beneficiaries, it must obtain which of
the following? - ✔✔Section 1115 Waiver
✔✔State oversight of MCO focuses on what? - ✔✔how managed care is provided, what
MCOs can and cannot do in carrying out their business operations
✔✔Which of the following electronic transactions does HIPAA not standardize? -
✔✔Electronic medical records
✔✔Which accreditation organization account for nearly all health plan accreditations? -
✔✔NCQA, URAC
✔✔Medical Directors typically have responsibility for what? - ✔✔utilization
management, benefits determinations for appeals, quality management
✔✔What are the special requirements for Medicare Advantage Plans? - ✔✔external
review, access standards, member appeals, enrollment
✔✔Beginning in 2014, what new distribution channel became available? - ✔✔State-
level health insurance exchanges
✔✔This rating entails the application of a standard rate to all groups within the
community being underwritten. - ✔✔Basic community rating
✔✔A set of rules and definitions that provide for uniform financial reporting in
accounting practices is? - ✔✔GAAP
✔✔T/F The Finance Director, not the Marketing Director, has responsibility for
enrollment forecasting. - ✔✔False
✔✔T/F Central to the privacy and security regulations is the concept of protected health
information. - ✔✔True
✔✔T/F States regulate all employer-sponsored health benefit plans. - ✔✔False
✔✔T/F In many states, premium taxes are the first largest source of state revenue over
individual and business income taxes. - ✔✔False
✔✔A high rate of member turnover is known as? - ✔✔churning
, ✔✔T/F All MCOs use a contracted provider network to deliver care to the plan's
enrollees. - ✔✔True
✔✔T/F Accreditation may be voluntary, but most states accept accreditation as meeting
the state's standard in the functional areas addressed by accreditation. - ✔✔True
✔✔Which part of Medicare is funded by pay-rollers tax deposits into hospital funds? -
✔✔Part A
Side note: Part C is not a benefit; private insurers
Part D is medication
✔✔T/F Most but not all MCO's have a board of directors - ✔✔True
✔✔T/F All states require PPOs to be accredited - ✔✔False
HMOs are required; Some PPOs can be accredited but they are not required
✔✔This form of accounting is based on the actual movement of cash, such as currency,
deposits, bill payments, etc. - ✔✔cash accounting
✔✔T/F States have the authority to examine the accounting and financial records of
MCOs and take action if their statutory surplus levels fall too low. - ✔✔True
✔✔What are the basic aspects of HIPAAs administrative simplifications? - ✔✔national
provider identifier, privacy of medical information, transactions and code sets, security
of medical information
✔✔T/F To be eligible to join a Part C plan, beneficiaries have to already had Medicare
Part A and B - ✔✔True
✔✔T/F A participating provider is permitted to balance bill a member for any amount not
paid due to the application of a fee schedule or other provider payment mechanism -
✔✔False
✔✔What is represented as the backbone of the MCOs operations? - ✔✔information
systems
✔✔Which of the following is not a measure in the Medicare Quality Bonus Program (i.e.
the "Stars" program) for Medicare Advantage plans: - ✔✔Reducing costs
✔✔Refers to the day-to-day functions of the finance department such tracking all money
that comes in and goes out. - ✔✔Operational finance
