HOM 5307 Test Questions with Correct Answers Latest Update 2025-2026
Behavioral change tools include all but which of the following?
Analytics
Termination from the network
Mission clarity
Communications - Answers Termination from the network
Fee-for-service physicians are financially rewarded for good disease management in most environments.
T or F - Answers False
The Managed care backlash resulted in which of the following?
A reduction in HMO membership
New federal and state laws and regulations
Reduced administrative costs - Answers A reduction in HMO membership
New federal and state laws and regulations
Which of the following is a typical complaint providers have about health plan provider profiling?
I get different results using my own data
My patients are sicker than other providers' patients
The quality and cost measures used are not accurate enough
All the above - Answers
The HMO Act of 1973 did contributed to the growth of managed care
T or F - Answers True
Which of the following forms of hospital payment contain no elements of risk sharing by the hospital?
DRGs and MS-DRGs
Per diem
,Capitation
Sliding scale FFS - Answers Sliding scale FFS
PSOs, created by the BBA of 1997, proved to be very popular and successful.
T or F - Answers False
In January 2006, what large federal prescription drug program was implemented that offered pharmacy
benefits to more than 40 million people at that time and is expected to increase by 30% throughout the
next decade?
The Department of Defense TRICOR program
Public Health Service and Indian Health Service
State Medicaid programs
Medicare Part D - Answers Medicare Part D
Managed care is best described as:
A broad and constantly changing array of health plans employers, unions, and other purchasers of care
that attempt to manage cost, quality, and access to that care
A broad changing array of health plans employers, unions, and other purchasers of care.
A constantly changing array of unions, and other purchasers of care that attempt to manage cost,
quality, and access to that care
A array of health plans employers, unions, and other purchasers of care that attempt to manage cost,
quality, and access to that care - Answers A broad and constantly changing array of health plans
employers, unions, and other purchasers of care that attempt to manage cost, quality, and access to
that care
Consolidation in the payer industry has resulted in most hospitals being unable to obtain adequate rate
increases.
T or F - Answers False
Which organization(s) need a Corporate Compliance Officer (CCO)?
Hospitals
, Health plans with a Medicare Advantage risk contract
Every organization that provides health care - Answers Hospitals and Health plans with a Medicare
Advantage risk contract
Health Plan Employer Data and Information Set is the less widely used set of measures for reporting on
managed behavioral health care.
T or F - Answers False
The following term refers to an all-inclusive rate paid by the HMO for both institutional and professional
services:
Bundled payment
Per diem
Case rate
Straight DRGs - Answers Bundled payment
The original impetus of HMOs development came from:
Providers seeking patient revenues
Insurance companies
Consumers seeking access to health care
A & C Only - Answers Providers seeking patient revenues and Consumers seeking access to health care
HMOs are licensed as health insurance companies.
True
False - Answers false
Common sources of information that trigger DM include:
Claims
Pharmacy data
Laboratory tests
A & b oNLY - Answers Claims and pharmacy
The GPWW requires the participation of a hospital and the formation of a group practice.
Behavioral change tools include all but which of the following?
Analytics
Termination from the network
Mission clarity
Communications - Answers Termination from the network
Fee-for-service physicians are financially rewarded for good disease management in most environments.
T or F - Answers False
The Managed care backlash resulted in which of the following?
A reduction in HMO membership
New federal and state laws and regulations
Reduced administrative costs - Answers A reduction in HMO membership
New federal and state laws and regulations
Which of the following is a typical complaint providers have about health plan provider profiling?
I get different results using my own data
My patients are sicker than other providers' patients
The quality and cost measures used are not accurate enough
All the above - Answers
The HMO Act of 1973 did contributed to the growth of managed care
T or F - Answers True
Which of the following forms of hospital payment contain no elements of risk sharing by the hospital?
DRGs and MS-DRGs
Per diem
,Capitation
Sliding scale FFS - Answers Sliding scale FFS
PSOs, created by the BBA of 1997, proved to be very popular and successful.
T or F - Answers False
In January 2006, what large federal prescription drug program was implemented that offered pharmacy
benefits to more than 40 million people at that time and is expected to increase by 30% throughout the
next decade?
The Department of Defense TRICOR program
Public Health Service and Indian Health Service
State Medicaid programs
Medicare Part D - Answers Medicare Part D
Managed care is best described as:
A broad and constantly changing array of health plans employers, unions, and other purchasers of care
that attempt to manage cost, quality, and access to that care
A broad changing array of health plans employers, unions, and other purchasers of care.
A constantly changing array of unions, and other purchasers of care that attempt to manage cost,
quality, and access to that care
A array of health plans employers, unions, and other purchasers of care that attempt to manage cost,
quality, and access to that care - Answers A broad and constantly changing array of health plans
employers, unions, and other purchasers of care that attempt to manage cost, quality, and access to
that care
Consolidation in the payer industry has resulted in most hospitals being unable to obtain adequate rate
increases.
T or F - Answers False
Which organization(s) need a Corporate Compliance Officer (CCO)?
Hospitals
, Health plans with a Medicare Advantage risk contract
Every organization that provides health care - Answers Hospitals and Health plans with a Medicare
Advantage risk contract
Health Plan Employer Data and Information Set is the less widely used set of measures for reporting on
managed behavioral health care.
T or F - Answers False
The following term refers to an all-inclusive rate paid by the HMO for both institutional and professional
services:
Bundled payment
Per diem
Case rate
Straight DRGs - Answers Bundled payment
The original impetus of HMOs development came from:
Providers seeking patient revenues
Insurance companies
Consumers seeking access to health care
A & C Only - Answers Providers seeking patient revenues and Consumers seeking access to health care
HMOs are licensed as health insurance companies.
True
False - Answers false
Common sources of information that trigger DM include:
Claims
Pharmacy data
Laboratory tests
A & b oNLY - Answers Claims and pharmacy
The GPWW requires the participation of a hospital and the formation of a group practice.
