HOM 5307 EXAM 2 SET 3 ACTUAL QUESTIONS AND ANSWERS
Which statement is not true regarding why specialized plans are more successful in Medicaid managed
care? - CORRECT ANSWER✅✅Medicaid focused plans are only owned by health systems
Which key legislative mandates have included information technology for MCO? - CORRECT
ANSWER✅✅-HIPAA
-PPACA
-HITECH
The rate formula typically adjusts the based rate for all of the following factors except: - CORRECT
ANSWER✅✅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. - CORRECT ANSWER✅✅Adequate
Which of the following is FALSE regarding HIPAA regulation? - CORRECT ANSWER✅✅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. - CORRECT ANSWER✅✅True
Poor ________ is a key sales challenge for both the employer-sponsored and direct markets. - CORRECT
ANSWER✅✅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. - CORRECT ANSWER✅✅True
_________ are the intermediary typically focused on smaller employers and are compensated based on
commissions paid by the health plan. - CORRECT ANSWER✅✅Brokers and consultants
Which statement is not true regarding why specialized plans are more successful in Medicaid managed
care? - CORRECT ANSWER✅✅Medicaid focused plans are only owned by health systems
Which key legislative mandates have included information technology for MCO? - CORRECT
ANSWER✅✅-HIPAA
-PPACA
-HITECH
The rate formula typically adjusts the based rate for all of the following factors except: - CORRECT
ANSWER✅✅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. - CORRECT ANSWER✅✅Adequate
Which of the following is FALSE regarding HIPAA regulation? - CORRECT ANSWER✅✅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. - CORRECT ANSWER✅✅True
Poor ________ is a key sales challenge for both the employer-sponsored and direct markets. - CORRECT
ANSWER✅✅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. - CORRECT ANSWER✅✅True
_________ are the intermediary typically focused on smaller employers and are compensated based on
commissions paid by the health plan. - CORRECT ANSWER✅✅Brokers and consultants
