HOM 5307 Practice Exam Questions Answered 100%
True or false? Durable Medical Equipment Suppliers are considered high risk operations for
fraud control.
True
True or False? Effective fraud control must include ongoing and agile enhancements to efforts
of fraud detection and prevention.
True
True or False? Fraud control effectiveness is easy to measure and assess.
False
True or False? Health Care Fraud is not an issue for managed care organizations.
False
True or False? Miami, Florida is known as the "ground zero" for health care fraud.
True
Critical measures in the contact center include:
Abandon rate
Member services is responsible for all of the following activities, except:
Adjudicating claims
The greatest volume of interactions between an health plan and its members will occur by
means of:
Telephone
True or False? Although important, the provision of general information to members should
not be considered to be one of the key aspects of member services.
False
, True or False? Appeal of coverage denial reviews are a distinctly formal process governed by
both state and federal laws.
True
True or False? It is important for all CSRs to be able to address all aspects of plan operations.
False
True or False? Member services and membership services are synonymous terms.
False
True or False? There is no legal distinction between a member complaint and a grievance.
False
Which is not a key supporting function of the member services center?
Member enrollment
Which of the following is the leading reason for member complaints?
Claims issues
True or False? Consumers and small employers may shop for and purchase health insurance
through the Exchange as a result of the Children's Health Insurance Reauthorization Act of
2009.
False
True or False? Given the low payment rates in Medicaid, there is no interest in developing
incentives or pay-for-performance programs.
False
True or False? The most common reason cited by physicians for limiting their practice to
Medicaid consumers was low reimbursement rates.
True
True or false? Durable Medical Equipment Suppliers are considered high risk operations for
fraud control.
True
True or False? Effective fraud control must include ongoing and agile enhancements to efforts
of fraud detection and prevention.
True
True or False? Fraud control effectiveness is easy to measure and assess.
False
True or False? Health Care Fraud is not an issue for managed care organizations.
False
True or False? Miami, Florida is known as the "ground zero" for health care fraud.
True
Critical measures in the contact center include:
Abandon rate
Member services is responsible for all of the following activities, except:
Adjudicating claims
The greatest volume of interactions between an health plan and its members will occur by
means of:
Telephone
True or False? Although important, the provision of general information to members should
not be considered to be one of the key aspects of member services.
False
, True or False? Appeal of coverage denial reviews are a distinctly formal process governed by
both state and federal laws.
True
True or False? It is important for all CSRs to be able to address all aspects of plan operations.
False
True or False? Member services and membership services are synonymous terms.
False
True or False? There is no legal distinction between a member complaint and a grievance.
False
Which is not a key supporting function of the member services center?
Member enrollment
Which of the following is the leading reason for member complaints?
Claims issues
True or False? Consumers and small employers may shop for and purchase health insurance
through the Exchange as a result of the Children's Health Insurance Reauthorization Act of
2009.
False
True or False? Given the low payment rates in Medicaid, there is no interest in developing
incentives or pay-for-performance programs.
False
True or False? The most common reason cited by physicians for limiting their practice to
Medicaid consumers was low reimbursement rates.
True
