HOM 5307 Exam 2 Set 3 Exam Questions
and answers
Which statement is not true regarding why specialized plans are more
successful in Medicaid managed care? - -Medicaid focused plans are only
owned by health systems
- Which key legislative mandates have included information technology for
MCO? - --HIPAA
-PPACA
-HITECH
- The rate formula typically adjusts the based rate for all of the following
factors except: - -eating habits
- ________ rates are high enough to generate sufficient revenue to cover all
claims and other plan expenses and to yield an acceptable return on equity. -
-Adequate
- Which of the following is FALSE regarding HIPAA regulation? - -State laws
regulating health insurance must always be preempted by HIPAA
- T or F: Appeal of coverage denial reviews are a distinctly formal process
governed by both state and federal laws. - -True
- Poor ________ is a key sales challenge for both the employer-sponsored and
direct markets. - -customer insight
- T or F: The U.S. Department of Labor is the federal agency which has
promulgated regulations setting forth minimum requirements for employee
benefit plan procedures pertaining to claims for benefits by plan participants
and beneficiaries. - -True
- _________ are the intermediary typically focused on smaller employers and
are compensated based on commissions paid by the health plan. - -Brokers
and consultants
- T or F: A majority of U.S. employers' health benefits plans are effective on
January 1 of the subsequent year. - -True
- The minimum loss ratio is ____% for individuals and small groups and ____%
for large groups under the ACA. - -80%, 85%
and answers
Which statement is not true regarding why specialized plans are more
successful in Medicaid managed care? - -Medicaid focused plans are only
owned by health systems
- Which key legislative mandates have included information technology for
MCO? - --HIPAA
-PPACA
-HITECH
- The rate formula typically adjusts the based rate for all of the following
factors except: - -eating habits
- ________ rates are high enough to generate sufficient revenue to cover all
claims and other plan expenses and to yield an acceptable return on equity. -
-Adequate
- Which of the following is FALSE regarding HIPAA regulation? - -State laws
regulating health insurance must always be preempted by HIPAA
- T or F: Appeal of coverage denial reviews are a distinctly formal process
governed by both state and federal laws. - -True
- Poor ________ is a key sales challenge for both the employer-sponsored and
direct markets. - -customer insight
- T or F: The U.S. Department of Labor is the federal agency which has
promulgated regulations setting forth minimum requirements for employee
benefit plan procedures pertaining to claims for benefits by plan participants
and beneficiaries. - -True
- _________ are the intermediary typically focused on smaller employers and
are compensated based on commissions paid by the health plan. - -Brokers
and consultants
- T or F: A majority of U.S. employers' health benefits plans are effective on
January 1 of the subsequent year. - -True
- The minimum loss ratio is ____% for individuals and small groups and ____%
for large groups under the ACA. - -80%, 85%
