HOM 5307 Final Practice Questions Answered 100%
Each of the following is a traditional way to group a member, except:
Answers:
A. Gender
B. Claims experience
C. Lifestyle
D. B & C
D
T/F: Process measures of health care performance focus on the context in which care and
services are not provided.
T
Which of the following is the leading reason for member complaints?
Answers:
A. Enrollment issues such as a missing ID card
B. Interactions with their PCP
C. Lack of coverage
D. Claims issues
D
T/F: Although important, the provision of general information to members should not be
considered to be one of the key aspects of member services.
F
Which key legislative mandates have included information technology for MCOs?
A. HIPAA
,B. PPACA
C. HITECH
D. All of the above
D
Subrogation is defined as
A. The right to recover any damages the member may receive from a third party who
assumes responsibility for an accidental injury
B. The practice of coordinating with other group health insurance benefits
C. Reducing payment liability due to a motorcycle accident
D. Reducing payment liability due to a job-related injury or illness
A
_ is the term for the rate at which medical services are used.
A. Consumption
B. Budgets
C. Utilization
D. None of the above
C
To earn NCQA accreditation, an organization must meet rigorous _ standards designed to
ensure that this key health plan function promotes good medicine rather than acting as an
arbitrary barrier to care.
A. Utilization management
B. Preventive health services
C. Credentialing
D. B & C
, A
Critical measures in the contact center include:
A. Enrollment turnaround time
B. Abandon rate
C. Claims auto-adjudication rate
D. A & C
B
T/F: Health plans are increasingly looking at "retail" concepts of sales and marketing.
T
The rate formula typically adjusts the base rate for all of the following factors except:
A. Demographics
B. Geographical area
C. Eating habits
D. All of the above
C
_ is a key driver of the recent investment in improving health plan marketing.
A. Increasing cost
B. Growth of consumer-directed products
C. Emerging Medicare products
D. B & C
D
Each of the following are characteristic of high performing direct markets sales, except
Each of the following is a traditional way to group a member, except:
Answers:
A. Gender
B. Claims experience
C. Lifestyle
D. B & C
D
T/F: Process measures of health care performance focus on the context in which care and
services are not provided.
T
Which of the following is the leading reason for member complaints?
Answers:
A. Enrollment issues such as a missing ID card
B. Interactions with their PCP
C. Lack of coverage
D. Claims issues
D
T/F: Although important, the provision of general information to members should not be
considered to be one of the key aspects of member services.
F
Which key legislative mandates have included information technology for MCOs?
A. HIPAA
,B. PPACA
C. HITECH
D. All of the above
D
Subrogation is defined as
A. The right to recover any damages the member may receive from a third party who
assumes responsibility for an accidental injury
B. The practice of coordinating with other group health insurance benefits
C. Reducing payment liability due to a motorcycle accident
D. Reducing payment liability due to a job-related injury or illness
A
_ is the term for the rate at which medical services are used.
A. Consumption
B. Budgets
C. Utilization
D. None of the above
C
To earn NCQA accreditation, an organization must meet rigorous _ standards designed to
ensure that this key health plan function promotes good medicine rather than acting as an
arbitrary barrier to care.
A. Utilization management
B. Preventive health services
C. Credentialing
D. B & C
, A
Critical measures in the contact center include:
A. Enrollment turnaround time
B. Abandon rate
C. Claims auto-adjudication rate
D. A & C
B
T/F: Health plans are increasingly looking at "retail" concepts of sales and marketing.
T
The rate formula typically adjusts the base rate for all of the following factors except:
A. Demographics
B. Geographical area
C. Eating habits
D. All of the above
C
_ is a key driver of the recent investment in improving health plan marketing.
A. Increasing cost
B. Growth of consumer-directed products
C. Emerging Medicare products
D. B & C
D
Each of the following are characteristic of high performing direct markets sales, except
