HOM 5307 Exam 1 Set 2 Exam
Questions and Answers
Key common characteristics of PPOs include: - -Selected provider panels
Negotiated payment rates
Consumer choice &
Utilization management
- EPOs share similarities with: - -PPOs and HMOs
- Commonly recognized HMOs include: - -IPAs
- Capitation is usually defined as: - -Prepayment for services on a fixed, per
member per month basis
- In what model does an HMO contract with more than one group practice
provide medical services to its members? - -Network model
- Advantages of an IPA include: - -Broader physician choice for members
- T or F: Board of Directors has final responsibility for all aspects of an
independent HMO - -True
- T or F: In the medical management area, committees serve to diffuse some
elements of responsibility and allow important input from the field into
procedure and policy or even into case-specific interpretation of existing
policy. - -True
- T or F: The function of the board is governance: overseeing and
maintaining final
responsibility for the plan. Final approval authority of corporate bylaws rests
with the board as does setting and approving policy. General oversight of the
profitability or reserve status rests with the board, as does oversight and
approval of significant fiscal events and quality management. - -True
- T or F: Considerations for successful network development include
geographic accessibility and hospital-related needs. - -True
- T or F: Hospital consolidation has been blocked more often than not by the
Department of Justice (DOJ) and/or the Federal Trade Commission (FTC). - -
False
- T or F: Managed care plans perform onsite reviews of hospitals and
ambulatory surgical centers. - -False
Questions and Answers
Key common characteristics of PPOs include: - -Selected provider panels
Negotiated payment rates
Consumer choice &
Utilization management
- EPOs share similarities with: - -PPOs and HMOs
- Commonly recognized HMOs include: - -IPAs
- Capitation is usually defined as: - -Prepayment for services on a fixed, per
member per month basis
- In what model does an HMO contract with more than one group practice
provide medical services to its members? - -Network model
- Advantages of an IPA include: - -Broader physician choice for members
- T or F: Board of Directors has final responsibility for all aspects of an
independent HMO - -True
- T or F: In the medical management area, committees serve to diffuse some
elements of responsibility and allow important input from the field into
procedure and policy or even into case-specific interpretation of existing
policy. - -True
- T or F: The function of the board is governance: overseeing and
maintaining final
responsibility for the plan. Final approval authority of corporate bylaws rests
with the board as does setting and approving policy. General oversight of the
profitability or reserve status rests with the board, as does oversight and
approval of significant fiscal events and quality management. - -True
- T or F: Considerations for successful network development include
geographic accessibility and hospital-related needs. - -True
- T or F: Hospital consolidation has been blocked more often than not by the
Department of Justice (DOJ) and/or the Federal Trade Commission (FTC). - -
False
- T or F: Managed care plans perform onsite reviews of hospitals and
ambulatory surgical centers. - -False
