HOM 5307 Exam 1 Set 2
Advantages of an IPA include: - ✔️✔️Broader physician choice for members
T or F: Board of Directors has final responsibility for all aspects of an independent HMO
- ✔️✔️True
T or F: In the medical management area, committees serve to diffuse some elements of
responsibility and allow important input from the field into procedure and policy or even
into case-specific interpretation of existing policy. - ✔️✔️True
T or F: The function of the board is governance: overseeing and maintaining final
responsibility for the plan. Final approval authority of corporate bylaws rests with the
board as does setting and approving policy. General oversight of the profitability or
reserve status rests with the board, as does oversight and approval of significant fiscal
events and quality management. - ✔️✔️True
T or F: Considerations for successful network development include geographic
accessibility and hospital-related needs. - ✔️✔️True
T or F: Hospital consolidation has been blocked more often than not by the Department
of Justice (DOJ) and/or the Federal Trade Commission (FTC). - ✔️✔️False
T or F: Managed care plans perform onsite reviews of hospitals and ambulatory surgical
centers. - ✔️✔️False
Who has final responsibility for all aspects of an independent HMO? - ✔️✔️Board of
Directors
Medical Directors typically have responsibility for: - ✔️✔️Utilization management
Benefits determinations for appeals
Quality management
Key common characteristics of PPOs include: - ✔️✔️Selected provider panels
Negotiated payment rates
Consumer choice &
Utilization management
EPOs share similarities with: - ✔️✔️PPOs and HMOs
Commonly recognized HMOs include: - ✔️✔️IPAs
Advantages of an IPA include: - ✔️✔️Broader physician choice for members
T or F: Board of Directors has final responsibility for all aspects of an independent HMO
- ✔️✔️True
T or F: In the medical management area, committees serve to diffuse some elements of
responsibility and allow important input from the field into procedure and policy or even
into case-specific interpretation of existing policy. - ✔️✔️True
T or F: The function of the board is governance: overseeing and maintaining final
responsibility for the plan. Final approval authority of corporate bylaws rests with the
board as does setting and approving policy. General oversight of the profitability or
reserve status rests with the board, as does oversight and approval of significant fiscal
events and quality management. - ✔️✔️True
T or F: Considerations for successful network development include geographic
accessibility and hospital-related needs. - ✔️✔️True
T or F: Hospital consolidation has been blocked more often than not by the Department
of Justice (DOJ) and/or the Federal Trade Commission (FTC). - ✔️✔️False
T or F: Managed care plans perform onsite reviews of hospitals and ambulatory surgical
centers. - ✔️✔️False
Who has final responsibility for all aspects of an independent HMO? - ✔️✔️Board of
Directors
Medical Directors typically have responsibility for: - ✔️✔️Utilization management
Benefits determinations for appeals
Quality management
Key common characteristics of PPOs include: - ✔️✔️Selected provider panels
Negotiated payment rates
Consumer choice &
Utilization management
EPOs share similarities with: - ✔️✔️PPOs and HMOs
Commonly recognized HMOs include: - ✔️✔️IPAs
