HOM 5307 Exam 2 Set 4 Questions
and Answers A+ Rated
The first and most rigorous area of NCQA review is: - -A health plan's own
internal quality control system
- What new distribution channel came available in 2014? - -State health
insurance exchanges
- T or F: Claims processing is the primary differentiator between health plans
in the marketplace. - -False
- T or F: MCO rely greatly on information systems to reduce costs and
improve service. - -True
- T or F: ERISA applies only to self-funded health plans. - -False
- T or F: Health care fraud as a crime gained the attention of government in
the mid-1980s when the Federal False Claims Act was amended with the
intent that it could be applied to false claims against Medicare and Medicaid.
- -True
- Typical health plan marketing functions include: - -Brand management
and market research
- Subrogation is defined as: - -The right to recover any damages the
member may receive from a third party who assumes responsibility for an
accidental injury
- T or F: Staffing ratios for the claims capability depend on the number
needed to meet volume demands while maintaining quality standards and
not relying on overtime hours as a permanent solution. - -True
- Which of the following does HIPAA regulate? - --electronic communications
between payers and providers
-portability and access standards
-guaranteed renewability of group coverage
- T or F: Health plans have typically invested heavily in sales and marketing,
relative to other functional areas - -False
- What is the single largest factor contributing to poor health outcomes? - -
Poverty
and Answers A+ Rated
The first and most rigorous area of NCQA review is: - -A health plan's own
internal quality control system
- What new distribution channel came available in 2014? - -State health
insurance exchanges
- T or F: Claims processing is the primary differentiator between health plans
in the marketplace. - -False
- T or F: MCO rely greatly on information systems to reduce costs and
improve service. - -True
- T or F: ERISA applies only to self-funded health plans. - -False
- T or F: Health care fraud as a crime gained the attention of government in
the mid-1980s when the Federal False Claims Act was amended with the
intent that it could be applied to false claims against Medicare and Medicaid.
- -True
- Typical health plan marketing functions include: - -Brand management
and market research
- Subrogation is defined as: - -The right to recover any damages the
member may receive from a third party who assumes responsibility for an
accidental injury
- T or F: Staffing ratios for the claims capability depend on the number
needed to meet volume demands while maintaining quality standards and
not relying on overtime hours as a permanent solution. - -True
- Which of the following does HIPAA regulate? - --electronic communications
between payers and providers
-portability and access standards
-guaranteed renewability of group coverage
- T or F: Health plans have typically invested heavily in sales and marketing,
relative to other functional areas - -False
- What is the single largest factor contributing to poor health outcomes? - -
Poverty
