Revenue Cycle Final UPDATED Exam
Questions and CORRECT Answers
Which is associated with contracted health care services that are provided to subscribers by
two or more physician multispecialty group practices? - Correct Answer- network model
HMO
Medicare and many states prohibit managed care contracts from containing __________,
which prevent providers from discussing all treatment options with patients, whether or not
the plan would provide reimbursement for services. - Correct Answer- gag clauses
A physician-hospital organization (PHO) is owned by hospital(s) and physician groups that
obtain managed care plan contracts. The physicians __________ and provide health care
services to plan members. - Correct Answer- maintain their own practices
Which is a method of controlling health care costs and quality of care by reviewing the
appropriateness and necessity of care provided to patients prior to the administration of care
or after care has been provided? - Correct Answer- utilization management
Which is created when a number of people are grouped for insurance purposes and the cost of
health care coverage is determined by employees' health status, age, sex, and occupation? -
Correct Answer- risk pool
A medical foundation is a nonprofit organization that contracts with and __________ the
clinical and business assets of physician practices. - Correct Answer- acquires
Which is associated with contracted health care services that are delivered to subscribers by
participating physicians who are members of an independent multispecialty group practice? -
Correct Answer- group model HMO
Some managed care plans contract out utilization management services to a utilization review
organization (URO), which is an entity that __________. - Correct Answer- establishes a
utilization management program and performs external utilization review services
To create flexibility in managed care plans, some HMOs and preferred provider organizations
have implemented a(n) __________, under which patients have freedom to use the managed
, care panel of providers or to self-refer to out-of-network providers. - Correct Answer- point-
of-service plan
A group practice without walls (GPWW) establishes a contract that allows physicians to
maintain their own offices and share services, such as __________. - Correct Answer-
appointment scheduling and billing
Which is associated with health care that is provided in an HMO-owned center or satellite
clinic or by physicians who belong to a specially formed medical group that serves the
HMO? - Correct Answer- closed-panel HMO
The primary care provider (PCP) is responsible for __________. - Correct Answer-
supervising and coordinating health care services for enrollees
Which consumer-directed health plan allows participants to enroll in a relatively inexpensive
high-deductible insurance plan and open a tax-deductible savings account to cover current
and future medical expenses? Money deposited (and earnings) is tax-deferred, and money
withdrawn to cover qualified medical expenses is tax-free. Money can be withdrawn for
purposes other than health care expenses after payment of income tax plus a 15 percent
penalty. Unused balances "roll over" from year to year, and if an employee changes jobs, he
or she can continue to use the fund to pay for qualified health care expenses. - Correct
Answer- health savings account
Which program resulted from the Balanced Budget Act of 1997 (BBA) and requires that
quality assurance activities are performed to improve the functioning of Medicare Advantage
(Medicare Part C) organizations? - Correct Answer- quality assessment and performance
improvement (QAPI)
Reviewing the appropriateness and necessity of care provided to patients prior to the
administration of care is called __________ review, and such review after care has been
provided is called __________ review. - Correct Answer- prospective; retrospective
The Health Maintenance Organization (HMO) Assistance Act of 1973 authorized grants and
loans to develop HMOs under private sponsorship. It defines a federally qualified HMO as
being certified to provide health care services to __________ enrollees. - Correct Answer-
Medicare and Medicaid
Questions and CORRECT Answers
Which is associated with contracted health care services that are provided to subscribers by
two or more physician multispecialty group practices? - Correct Answer- network model
HMO
Medicare and many states prohibit managed care contracts from containing __________,
which prevent providers from discussing all treatment options with patients, whether or not
the plan would provide reimbursement for services. - Correct Answer- gag clauses
A physician-hospital organization (PHO) is owned by hospital(s) and physician groups that
obtain managed care plan contracts. The physicians __________ and provide health care
services to plan members. - Correct Answer- maintain their own practices
Which is a method of controlling health care costs and quality of care by reviewing the
appropriateness and necessity of care provided to patients prior to the administration of care
or after care has been provided? - Correct Answer- utilization management
Which is created when a number of people are grouped for insurance purposes and the cost of
health care coverage is determined by employees' health status, age, sex, and occupation? -
Correct Answer- risk pool
A medical foundation is a nonprofit organization that contracts with and __________ the
clinical and business assets of physician practices. - Correct Answer- acquires
Which is associated with contracted health care services that are delivered to subscribers by
participating physicians who are members of an independent multispecialty group practice? -
Correct Answer- group model HMO
Some managed care plans contract out utilization management services to a utilization review
organization (URO), which is an entity that __________. - Correct Answer- establishes a
utilization management program and performs external utilization review services
To create flexibility in managed care plans, some HMOs and preferred provider organizations
have implemented a(n) __________, under which patients have freedom to use the managed
, care panel of providers or to self-refer to out-of-network providers. - Correct Answer- point-
of-service plan
A group practice without walls (GPWW) establishes a contract that allows physicians to
maintain their own offices and share services, such as __________. - Correct Answer-
appointment scheduling and billing
Which is associated with health care that is provided in an HMO-owned center or satellite
clinic or by physicians who belong to a specially formed medical group that serves the
HMO? - Correct Answer- closed-panel HMO
The primary care provider (PCP) is responsible for __________. - Correct Answer-
supervising and coordinating health care services for enrollees
Which consumer-directed health plan allows participants to enroll in a relatively inexpensive
high-deductible insurance plan and open a tax-deductible savings account to cover current
and future medical expenses? Money deposited (and earnings) is tax-deferred, and money
withdrawn to cover qualified medical expenses is tax-free. Money can be withdrawn for
purposes other than health care expenses after payment of income tax plus a 15 percent
penalty. Unused balances "roll over" from year to year, and if an employee changes jobs, he
or she can continue to use the fund to pay for qualified health care expenses. - Correct
Answer- health savings account
Which program resulted from the Balanced Budget Act of 1997 (BBA) and requires that
quality assurance activities are performed to improve the functioning of Medicare Advantage
(Medicare Part C) organizations? - Correct Answer- quality assessment and performance
improvement (QAPI)
Reviewing the appropriateness and necessity of care provided to patients prior to the
administration of care is called __________ review, and such review after care has been
provided is called __________ review. - Correct Answer- prospective; retrospective
The Health Maintenance Organization (HMO) Assistance Act of 1973 authorized grants and
loans to develop HMOs under private sponsorship. It defines a federally qualified HMO as
being certified to provide health care services to __________ enrollees. - Correct Answer-
Medicare and Medicaid
