HOM 5307 Final Exam Questions and
Answers
T/F: State mandated laws apply to self-funded employee benefits plans - -
FALSE
- T/F: ERISA applies only to self-funded health plans - -FALSE
- T/F: ERISA requires expedited review for claims involving urgent care - -
TRUE
- T/F: ERISA preempts all state laws - -FALSE
- What is the largest factor contributing to poor health outcomes? - -Poverty
- What is the leading reason for member complaints? - -Claims Issues
- The greatest volume of interaction between a health plan and its members
will occur by means of ? - -Telephone
- T/F: The common reason cited by physicians for limiting their practice to
Medicaid consumers was low reimbursement rates - -TRUE
- Member services is responsible for what activities? - -- Providing
information to members
- Helping members with any problems
- Handling member grievances and complaints
- Tracking and reporting patterns of problems encountered
- Enhancing the relationship between the members of the plan and the plan
itself
- NOT Adjudicating the claims
- What is the most significant piece of social legislation since 1965? - -The
patient protection and affordable care act of 2010
- Critical measure in the contacts center include - -Abandon rate
- T/F: Given the low payment rates in Medicaid, there is no interest in
developing incentive or pay for performance programs - -FALSE
- T/F: 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
Answers
T/F: State mandated laws apply to self-funded employee benefits plans - -
FALSE
- T/F: ERISA applies only to self-funded health plans - -FALSE
- T/F: ERISA requires expedited review for claims involving urgent care - -
TRUE
- T/F: ERISA preempts all state laws - -FALSE
- What is the largest factor contributing to poor health outcomes? - -Poverty
- What is the leading reason for member complaints? - -Claims Issues
- The greatest volume of interaction between a health plan and its members
will occur by means of ? - -Telephone
- T/F: The common reason cited by physicians for limiting their practice to
Medicaid consumers was low reimbursement rates - -TRUE
- Member services is responsible for what activities? - -- Providing
information to members
- Helping members with any problems
- Handling member grievances and complaints
- Tracking and reporting patterns of problems encountered
- Enhancing the relationship between the members of the plan and the plan
itself
- NOT Adjudicating the claims
- What is the most significant piece of social legislation since 1965? - -The
patient protection and affordable care act of 2010
- Critical measure in the contacts center include - -Abandon rate
- T/F: Given the low payment rates in Medicaid, there is no interest in
developing incentive or pay for performance programs - -FALSE
- T/F: 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
