HOM 5307 Exam 2 Set 1 |20
Questions and Answers
Which of the following is the leading reason for member complaints? - -
Claims issues
- Applicants/groups with poor credit histories may be required to do which of
the following? - --Produce a letter of credit
-Produce some form of collateral
-Pay premiums in advance of the coverage period
- Today's transactional processing systems auto adjudicate on average what
percentage of claims that are accepted into the processing system? - -75%
- T or F: Although important, the provision of general information to
members should not be considered to be one of the key aspects of member
services. - -False
- T or F: Member services and membership services are synonymous terms.
- -False
- T or F: ERISA is the summary plan description is a booklet that describes
the operative provisions of a plan in lay terms. - -True
- T or F: Durable Medical Equipment Suppliers are not considered high risk
operations for fraud control. - -False
- What are intermediaries in the employer-sponsored business called? - -
Brokers and Consultants
- T or F: Consumers and small employers may shop for and purchase health
insurance through the Exchange as a result of the Children's Health
Insurance Reauthorization Act of 2009. - -False
- What is the single most significant piece of social legislation since 1965? -
-The Patient Protection & Affordable Care Act of 2010
- T or F: Effective fraud control must include ongoing and agile
enhancements to efforts of fraud detection and prevention. - -True
- T or F: State mandated benefits laws apply to self-funded employee
benefits plans. - -False
Questions and Answers
Which of the following is the leading reason for member complaints? - -
Claims issues
- Applicants/groups with poor credit histories may be required to do which of
the following? - --Produce a letter of credit
-Produce some form of collateral
-Pay premiums in advance of the coverage period
- Today's transactional processing systems auto adjudicate on average what
percentage of claims that are accepted into the processing system? - -75%
- T or F: Although important, the provision of general information to
members should not be considered to be one of the key aspects of member
services. - -False
- T or F: Member services and membership services are synonymous terms.
- -False
- T or F: ERISA is the summary plan description is a booklet that describes
the operative provisions of a plan in lay terms. - -True
- T or F: Durable Medical Equipment Suppliers are not considered high risk
operations for fraud control. - -False
- What are intermediaries in the employer-sponsored business called? - -
Brokers and Consultants
- T or F: Consumers and small employers may shop for and purchase health
insurance through the Exchange as a result of the Children's Health
Insurance Reauthorization Act of 2009. - -False
- What is the single most significant piece of social legislation since 1965? -
-The Patient Protection & Affordable Care Act of 2010
- T or F: Effective fraud control must include ongoing and agile
enhancements to efforts of fraud detection and prevention. - -True
- T or F: State mandated benefits laws apply to self-funded employee
benefits plans. - -False
