HSA Exam 3 UPDATED Exam Questions
and CORRECT Answers
When Medicare pays a premium per member that is based on the member's county of residence,
it is called a(n): - CORRECT ANSWER risk plan
What is a risk plan - CORRECT ANSWER
What are limited benefit plans? - CORRECT ANSWER They only provide one or two
Medicaid benefits.
True or False? HEDIS is a data set of healthcare plans' service activities and is used to evaluate
healthcare plans. Although submission is voluntary, nearly 100% of health plans submit their
data to - CORRECT ANSWER true
What is HEDIS? - CORRECT ANSWER Healthcare Effectiveness Data and Information
Set
True or False? Managed care gatekeepers are the first point of contact with a managed care
patient. - CORRECT ANSWER False
True or False? Health maintenance organizations (HMOs) are the oldest type of managed care.
Members must see their primary care provider first in order to see a specialist. - CORRECT
ANSWER true
True or False? The fee-for-service (FFS) system was the traditional health insurance plan that
paid a fee for a service provided by the provider. This system increased healthcare costs because
there was no limit as to how much a provider could charge for a service. - CORRECT
ANSWER true
, _________ are a type of HMO and have similar rules to Medicare Advantage plans. CMS
reimburses the MCOs on a preset monthly basis per enrollee based on a forecasted budget. -
CORRECT ANSWER Medicare cost plans
________ is an evaluation of services once the services have been provided. This may occur to
assess treatment patterns of certain diseases. - CORRECT ANSWER Retrospective
utilization review
Describe what a health maintenance organization (HMO) is and list the four different types of
HMO models. - CORRECT ANSWER HMOs are the oldest type of managed care.
Members must see their primary care provider first in order to see a specialist.
What are the five common characteristics of managed care organizations (MCOs)? - CORRECT
ANSWER -They all establish relationships with organizations and providers to provide a
designated set of services to their members.
-They all establish criteria for their members to utilize the MCO.
-They all establish measures to estimate cost control.
-They all provide incentives to encourage health service resources
.
-They all provide and encourage utilization of programs to improve the health status of their
enrollees.
what are the four types of HMO MODELS - CORRECT ANSWER The four types of
HMO models are staff, group, network, and independent practice association.
what is the staff model? - CORRECT ANSWER The staff model hires providers to work
at a physical location.
and CORRECT Answers
When Medicare pays a premium per member that is based on the member's county of residence,
it is called a(n): - CORRECT ANSWER risk plan
What is a risk plan - CORRECT ANSWER
What are limited benefit plans? - CORRECT ANSWER They only provide one or two
Medicaid benefits.
True or False? HEDIS is a data set of healthcare plans' service activities and is used to evaluate
healthcare plans. Although submission is voluntary, nearly 100% of health plans submit their
data to - CORRECT ANSWER true
What is HEDIS? - CORRECT ANSWER Healthcare Effectiveness Data and Information
Set
True or False? Managed care gatekeepers are the first point of contact with a managed care
patient. - CORRECT ANSWER False
True or False? Health maintenance organizations (HMOs) are the oldest type of managed care.
Members must see their primary care provider first in order to see a specialist. - CORRECT
ANSWER true
True or False? The fee-for-service (FFS) system was the traditional health insurance plan that
paid a fee for a service provided by the provider. This system increased healthcare costs because
there was no limit as to how much a provider could charge for a service. - CORRECT
ANSWER true
, _________ are a type of HMO and have similar rules to Medicare Advantage plans. CMS
reimburses the MCOs on a preset monthly basis per enrollee based on a forecasted budget. -
CORRECT ANSWER Medicare cost plans
________ is an evaluation of services once the services have been provided. This may occur to
assess treatment patterns of certain diseases. - CORRECT ANSWER Retrospective
utilization review
Describe what a health maintenance organization (HMO) is and list the four different types of
HMO models. - CORRECT ANSWER HMOs are the oldest type of managed care.
Members must see their primary care provider first in order to see a specialist.
What are the five common characteristics of managed care organizations (MCOs)? - CORRECT
ANSWER -They all establish relationships with organizations and providers to provide a
designated set of services to their members.
-They all establish criteria for their members to utilize the MCO.
-They all establish measures to estimate cost control.
-They all provide incentives to encourage health service resources
.
-They all provide and encourage utilization of programs to improve the health status of their
enrollees.
what are the four types of HMO MODELS - CORRECT ANSWER The four types of
HMO models are staff, group, network, and independent practice association.
what is the staff model? - CORRECT ANSWER The staff model hires providers to work
at a physical location.
