HOM 5307 Final Exam Practice Questions
Answered 100%
Plans can receive bonus payments for high star quality ratings. The bonus payments can be
used to
All of the Above:
- provide additional benefits
- reduce cost sharing
- reduce enrollee premiums
T/F : Effective fraud control must include ongoing and agile enhancements to efforts of
fraud detection and prevention
TRUE
What electronic transaction does HIPAA not standardize?
Electronic medical records/claims
T/F: HIPAA mandates that federal confidentiality regulation overrule state laws regardless of
whether or not state laws impose more stringent requirements or standards
FALSE
Which of the following is FALSE regarding HIPAA regulation?
State laws regulating health insurance must always be preempted by HIPAA
Which type of MA plan is experiencing an increase in availability and enrollment due to
broad waiver from CMS?
Group retiree plan
T/F: Durable Medical Equipment Suppliers are considered high risk operation for
fraud control
, TRUE
What is most likely to cause the rise in Medicare enrollment in MA plans over the next few
decades?
Baby boomers interested in staying in managed care when becoming eligible for Medicare
Common types of healthcare fraud include
- Forging prescriptions
- Identity Theft to obtain care
- Duplicate billing
- Billing ofr more drugs than dispensed
T/F: The ACA will reduce enrollee cost sharing during the drug coverage gap
TRUE
If a plan's bid to CMS exceeds the benchmark, the plan must charge enrollees the difference
in the form of what?
Monthly Premium
T/F: Fraud control effectiveness is easy to measure and assess
FALSE
MA plans must have a quality improvement program that measures performance under the
program that includes
All of the Above:
- chronic care improvement programs (CCIP)
- quality improvement projects (QIP)
- health information systems
T/F: Miami Florida is known as ground zero for health case fraud
TRUE
Answered 100%
Plans can receive bonus payments for high star quality ratings. The bonus payments can be
used to
All of the Above:
- provide additional benefits
- reduce cost sharing
- reduce enrollee premiums
T/F : Effective fraud control must include ongoing and agile enhancements to efforts of
fraud detection and prevention
TRUE
What electronic transaction does HIPAA not standardize?
Electronic medical records/claims
T/F: HIPAA mandates that federal confidentiality regulation overrule state laws regardless of
whether or not state laws impose more stringent requirements or standards
FALSE
Which of the following is FALSE regarding HIPAA regulation?
State laws regulating health insurance must always be preempted by HIPAA
Which type of MA plan is experiencing an increase in availability and enrollment due to
broad waiver from CMS?
Group retiree plan
T/F: Durable Medical Equipment Suppliers are considered high risk operation for
fraud control
, TRUE
What is most likely to cause the rise in Medicare enrollment in MA plans over the next few
decades?
Baby boomers interested in staying in managed care when becoming eligible for Medicare
Common types of healthcare fraud include
- Forging prescriptions
- Identity Theft to obtain care
- Duplicate billing
- Billing ofr more drugs than dispensed
T/F: The ACA will reduce enrollee cost sharing during the drug coverage gap
TRUE
If a plan's bid to CMS exceeds the benchmark, the plan must charge enrollees the difference
in the form of what?
Monthly Premium
T/F: Fraud control effectiveness is easy to measure and assess
FALSE
MA plans must have a quality improvement program that measures performance under the
program that includes
All of the Above:
- chronic care improvement programs (CCIP)
- quality improvement projects (QIP)
- health information systems
T/F: Miami Florida is known as ground zero for health case fraud
TRUE
