HOM 5307 EXAM 1(100% SOLVED)
T/F
An IPA is an HMO that contracts directly with physicians and hospitals. - ANSWER
False
An IPA is an HMO that contracts with physicians, then health plan. An HMO contracts
directly with hospital
(A direct contract Open Panel HMO contracts directly with physicians and hospitals)
T/F
The defining feature of a direct contract model is the HMO contracting directly with a
hospital to provide acute services to its members - ANSWER false
the defining feature of a direct contract model is between the HMO and physicians.
Almost all models of HMOs contract directly with hospitals
T/F
HMOs are licensed as health insurance companies - ANSWER false
HMOs are licensed by states under certificate of authority (COA) rather than under an
insurance license
T/F
A PHO is usually a separate business entity requiring the participation of a hospital and
at least some of the hospital's admitting physicians - ANSWER true
PHO = physician hospital organization
T/F
hospitals purchased physician practices and employed physicians in the 1990s but will
no longer do so - ANSWER false
T/F
an IDS can be described as a legal entity consisting of more than one type of provider
to manage a populations' healthcare and/or contract with a payer organization -
ANSWER true
IDS = integrated delivery system
(Not all types of providers will be found in all IDS - it is highly variable)
T/F
the GPWW requires the participation of a hospital and the formation of a group practice
- ANSWER false
GPWW requires the practice of physicians that are actual members/employees of a
medical group
GPWW = group practice without walls
, EPOs share similarities with:
A- PPOs
B- HMOs
C - Point of Service
D - A & B - ANSWER D - PPOs and HMOs
EPO = exclusive physician organization
commonly recognized HMOs include:
A- IPAs
B- Network
C - Staff and group
D- All the above - ANSWER D- All of the above
T/F
PSOs, created by the BBA of 1997, proved to be very popular and successful -
ANSWER false
they failed spectacularly
PSO = physician service organization
BBA = balanced budget act
key common characteristics of PPOs include:
A- Selected provider panels
B- Negotiated payment rates
C- Consumer choice & Utilization management
D- All the above - ANSWER D- all of the above
advantages of an IPA include:
A- Broader physician choice for members
B- More convenient geographic access
C- Requires less start-up capital
D- All the above - ANSWER D- all of the above
(HMOs are extremely costly)
capitation is usually described as:
A- Fee-for-service including withhold provisions
B- Stop-loss reinsurance provisions
C- Prepayment for services on a fixed, per member per month basis
T/F
An IPA is an HMO that contracts directly with physicians and hospitals. - ANSWER
False
An IPA is an HMO that contracts with physicians, then health plan. An HMO contracts
directly with hospital
(A direct contract Open Panel HMO contracts directly with physicians and hospitals)
T/F
The defining feature of a direct contract model is the HMO contracting directly with a
hospital to provide acute services to its members - ANSWER false
the defining feature of a direct contract model is between the HMO and physicians.
Almost all models of HMOs contract directly with hospitals
T/F
HMOs are licensed as health insurance companies - ANSWER false
HMOs are licensed by states under certificate of authority (COA) rather than under an
insurance license
T/F
A PHO is usually a separate business entity requiring the participation of a hospital and
at least some of the hospital's admitting physicians - ANSWER true
PHO = physician hospital organization
T/F
hospitals purchased physician practices and employed physicians in the 1990s but will
no longer do so - ANSWER false
T/F
an IDS can be described as a legal entity consisting of more than one type of provider
to manage a populations' healthcare and/or contract with a payer organization -
ANSWER true
IDS = integrated delivery system
(Not all types of providers will be found in all IDS - it is highly variable)
T/F
the GPWW requires the participation of a hospital and the formation of a group practice
- ANSWER false
GPWW requires the practice of physicians that are actual members/employees of a
medical group
GPWW = group practice without walls
, EPOs share similarities with:
A- PPOs
B- HMOs
C - Point of Service
D - A & B - ANSWER D - PPOs and HMOs
EPO = exclusive physician organization
commonly recognized HMOs include:
A- IPAs
B- Network
C - Staff and group
D- All the above - ANSWER D- All of the above
T/F
PSOs, created by the BBA of 1997, proved to be very popular and successful -
ANSWER false
they failed spectacularly
PSO = physician service organization
BBA = balanced budget act
key common characteristics of PPOs include:
A- Selected provider panels
B- Negotiated payment rates
C- Consumer choice & Utilization management
D- All the above - ANSWER D- all of the above
advantages of an IPA include:
A- Broader physician choice for members
B- More convenient geographic access
C- Requires less start-up capital
D- All the above - ANSWER D- all of the above
(HMOs are extremely costly)
capitation is usually described as:
A- Fee-for-service including withhold provisions
B- Stop-loss reinsurance provisions
C- Prepayment for services on a fixed, per member per month basis
