HOM 5307 Exam 1
Capitation is usually defined as - Correct Answer-Prepayment for services on a fixed,
per member per month basis
CH 4: when selecting a hosptial during the network development phase, an HMO
considers: - Correct Answer-occupancy rate
cost of services
scope of services
The original impetus of HMOs development came from - Correct Answer-Providers
seeking patient revenues
Consumers seeking access to healthcare
Employers
Ancillary services are broadly divided into the following categories - Correct Answer-
diagnostic and therapeutic
The integral compound of managed care are: - Correct Answer-Wellness and
prevention
Primary care orientation
Utilization management
Prior to the 1970s, health maintenance organizations were known as - Correct Answer-
prepaid practice groups
In what model does an HMO contract with more than one group practice provide
medical services to its members? - Correct Answer-Network model
Advantages of an IPA include - Correct Answer-broader physician choice for members
more convenient geographic access
requires less start-up capital
Managed care is best described as: - Correct Answer-A broad and constantly changing
array of health plans employers, unions and other purchaser of care that attempt to
manage cost, quality, and access to that care
Commonly recognized HMOs include: - Correct Answer-IPAs
, Network
Staff and group
The managed care backlash resulted in which of the following? - Correct Answer-A
reduction in HMO membership
New federal and state law regulations
EPOs share similarities with: - Correct Answer-PPOs
HMOs
state and federal regulations consistently apply network access standards to: - Correct
Answer-HMOs
POS (point of service) plan
A PHO (physician health organization) is usually a separate business entity requiring
the participation of a hospital and at least some of the hospital's admitting physicians -
Correct Answer-true
PPOs differ HMOs bc they do not accept capitation risk and enrollees who are willing to
pay higher cost sharing may access providers that are not in the contracted network -
Correct Answer-true
which of the following organizations may conduct primary verification pf a physician's
credentials? - Correct Answer-HMO
PPO
CVO
Blue cross began as a physician service bureau in the 1930s. - Correct Answer-false,
began as hospital only. Blue shield was the physician review
The HIPDB is a national health care fraud and abuse data collection program for the
reporting and disclosure of certain final adverse actions taken against health care
providers, suppliers, or practioners - Correct Answer-true
The Balance Budget Act (BBA) pf 1997 resulted in a major increase in enrollment -
Correct Answer-false
Considerations for successful network development include geographic accessibility
and hospital related needs - Correct Answer-true
Health care costs inflation has remained consistent since 1995 - Correct Answer-false
physicians avoid working for hospitals as much as possible - Correct Answer-false
CH 2: HMOs are licensed as health insurance companies - Correct Answer-False,
licensed under a certificate of authority
Capitation is usually defined as - Correct Answer-Prepayment for services on a fixed,
per member per month basis
CH 4: when selecting a hosptial during the network development phase, an HMO
considers: - Correct Answer-occupancy rate
cost of services
scope of services
The original impetus of HMOs development came from - Correct Answer-Providers
seeking patient revenues
Consumers seeking access to healthcare
Employers
Ancillary services are broadly divided into the following categories - Correct Answer-
diagnostic and therapeutic
The integral compound of managed care are: - Correct Answer-Wellness and
prevention
Primary care orientation
Utilization management
Prior to the 1970s, health maintenance organizations were known as - Correct Answer-
prepaid practice groups
In what model does an HMO contract with more than one group practice provide
medical services to its members? - Correct Answer-Network model
Advantages of an IPA include - Correct Answer-broader physician choice for members
more convenient geographic access
requires less start-up capital
Managed care is best described as: - Correct Answer-A broad and constantly changing
array of health plans employers, unions and other purchaser of care that attempt to
manage cost, quality, and access to that care
Commonly recognized HMOs include: - Correct Answer-IPAs
, Network
Staff and group
The managed care backlash resulted in which of the following? - Correct Answer-A
reduction in HMO membership
New federal and state law regulations
EPOs share similarities with: - Correct Answer-PPOs
HMOs
state and federal regulations consistently apply network access standards to: - Correct
Answer-HMOs
POS (point of service) plan
A PHO (physician health organization) is usually a separate business entity requiring
the participation of a hospital and at least some of the hospital's admitting physicians -
Correct Answer-true
PPOs differ HMOs bc they do not accept capitation risk and enrollees who are willing to
pay higher cost sharing may access providers that are not in the contracted network -
Correct Answer-true
which of the following organizations may conduct primary verification pf a physician's
credentials? - Correct Answer-HMO
PPO
CVO
Blue cross began as a physician service bureau in the 1930s. - Correct Answer-false,
began as hospital only. Blue shield was the physician review
The HIPDB is a national health care fraud and abuse data collection program for the
reporting and disclosure of certain final adverse actions taken against health care
providers, suppliers, or practioners - Correct Answer-true
The Balance Budget Act (BBA) pf 1997 resulted in a major increase in enrollment -
Correct Answer-false
Considerations for successful network development include geographic accessibility
and hospital related needs - Correct Answer-true
Health care costs inflation has remained consistent since 1995 - Correct Answer-false
physicians avoid working for hospitals as much as possible - Correct Answer-false
CH 2: HMOs are licensed as health insurance companies - Correct Answer-False,
licensed under a certificate of authority
