HOM 5307 Exam 2 Set 2 Exam Questions
and Answers
A set of causes and conditions that come together in a series of steps to
transfer inputs into outcomes is called - -Structure
- T or F: It is important for all CSRs to be able to address all aspects of plan
operations. - -False
- T or F: Providers, employers, agents, and members expect many health
plan services to be available online. The preferred approach to allow access
is through web-portals and interactive voice response systems. - -True
- T or F: All accredited health plans are required to report on their clinical
performance through HEDIS. - -False
- To earn NCQA accreditation, an organization must meet rigorous _________
standards designed to ensure that this key health plan function promotes
good medicine rather than acting as an arbitrary barrier to care. - -
Utilization management
- Member services are responsible for - --providing information to members
-helping members with any problems
-handling member grievances and complaints
-tracking and reporting patterns of problems encountered
-enhancing the relationship between the members of the plan and the plan
itself
- T or F: ERISA preempts all state laws. - -False
- The best data source for any health plan is ______ because it implicitly
recognizes all the plan-specific characteristics. - -Experience
- T or F: Practice guidelines that can be repeated over and over again with
the same result are always considered to be valid. - -False
- T or F: While the federal government requires Medicare plans to submit
performance data, most participation in such programs is voluntary. - -False
- T or F: The most common form of claims submissions is electronic. - -True
- _______ is the term for the rate at which medical services are used. - -
Utilization
and Answers
A set of causes and conditions that come together in a series of steps to
transfer inputs into outcomes is called - -Structure
- T or F: It is important for all CSRs to be able to address all aspects of plan
operations. - -False
- T or F: Providers, employers, agents, and members expect many health
plan services to be available online. The preferred approach to allow access
is through web-portals and interactive voice response systems. - -True
- T or F: All accredited health plans are required to report on their clinical
performance through HEDIS. - -False
- To earn NCQA accreditation, an organization must meet rigorous _________
standards designed to ensure that this key health plan function promotes
good medicine rather than acting as an arbitrary barrier to care. - -
Utilization management
- Member services are responsible for - --providing information to members
-helping members with any problems
-handling member grievances and complaints
-tracking and reporting patterns of problems encountered
-enhancing the relationship between the members of the plan and the plan
itself
- T or F: ERISA preempts all state laws. - -False
- The best data source for any health plan is ______ because it implicitly
recognizes all the plan-specific characteristics. - -Experience
- T or F: Practice guidelines that can be repeated over and over again with
the same result are always considered to be valid. - -False
- T or F: While the federal government requires Medicare plans to submit
performance data, most participation in such programs is voluntary. - -False
- T or F: The most common form of claims submissions is electronic. - -True
- _______ is the term for the rate at which medical services are used. - -
Utilization
