Question 1

A management service organization (MSO)  is usually owned by physicians or a hospital and provides practice management (administrative and support)  services to __________.

Accepted Answer

A)   government health programs
B)   individual physician practices
C)   managed care organizations
D)   third-party payersE) A) and D)
F) All of the above

Question 2

Which type of HMO contracts health services that are delivered to subscribers by physicians who remain in their own office settings?

Accepted Answer

A)   independent practice association
B)   point-of-service plan
C)   preferred provider organization
D)   triple-option planE) B) and C)
F) A) and B)

Question 3

The National Committee for Quality Assurance (NCQA)  reviews managed care plans and develops report cards to __________.

Accepted Answer

A)   allow health care consumers to make informed decisions when selecting a plan
B)   control the quality and utilization of health care services to patient populations
C)   establish punitive monetary penalties that are paid by poor quality providers
D)   guarantee the financial stability of managed care plans and their organizationsE) A) and B)
F) None of the above

Question 4

Which consumer-directed health plan allows tax-exempt accounts to be offered by employers with 50 or more employees, which individuals then use to pay health care bills? Funds must be used for qualified health care expenses, and unspent money can be accumulated for future years. If an employee changes jobs, he or she can continue to use the funds to pay for qualified health care expenses.

Accepted Answer

A)   customized sub-capitation plan
B)   flexible spending account
C)   health savings account
D)   health reimbursement arrangementE) A) and C)
F) A) and D)

Question 5

Accreditation organizations develop standards that are reviewed during an evaluation process that is conducted both offsite and onsite. The evaluation process is called a(n)  __________.

Accepted Answer

A)   audit
B)   inspection
C)   review
D)   surveyE) B) and C)
F) A) and D)

Question 6

Which involves arranging appropriate health care services for the patient who is being released from an inpatient hospitalization?

Accepted Answer

A)   concurrent review
B)   discharge planning
C)   preadmission certification
D)   preauthorizationE) B) and D)
F) A) and B)

Question 7

Which is a private, not-for-profit organization that assesses the quality of managed care plans in the United States and releases the data to the public for consideration when selecting a managed care plan?

Accepted Answer

A)   Centers for Medicare and Medicaid Services
B)   department of health in each state
C)   National Committee for Quality Assurance
D)   The Joint CommissionE) B) and C)
F) A) and D)

Question 8

Managed health care was developed as a way to provide affordable, comprehensive, prepaid health care services to __________.

Accepted Answer

A)   enrollees
B)   patients
C)   payers
D)   providersE) None of the above
F) C) and D)

Question 9

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?

Accepted Answer

A)   health information management
B)   risk management
C)   quality management
D)   utilization managementE) A) and B)
F) A) and C)

Question 10

Which is associated with contracted health care services that are delivered to subscribers by individual physicians in the community?

Accepted Answer

A)   direct contract model HMO
B)   group model HMO
C)   network model HMO
D)   staff model HMOE) None of the above
F) C) and D)

Question 11

A triple option plan is also called a __________ or flexible benefit plan because of the different benefit plans and extra coverage options provided through the insurer or third-party administrator.

Accepted Answer

A)   cafeteria plan
B)   optional contract
C)   rider
D)   underwriterE) C) and D)
F) B) and D)

Question 12

The Amendment to the HMO Act of 1973 allowed federally qualified HMOs to permit members to __________.

Accepted Answer

A)   always use HMO physicians and be only partially reimbursed
B)   occasionally use non-HMO physicians and be partially reimbursed
C)   pick a non-HMO physician and be totally reimbursed
D)   switch to using non-HMO physicians and be totally reimbursedE) B) and C)
F) A) and B)

Question 13

Which is a review for medical necessity of inpatient care prior to the patient's admission?

Accepted Answer

A)   concurrent review
B)   discharge planning
C)   preadmission certification
D)   preauthorizationE) A) and C)
F) B) and C)

Question 14

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.

Accepted Answer

A)   independent practice association
B)   point-of-service plan
C)   preferred provider organization
D)   triple option planE) C) and D)
F) B) and D)

Exam 3: Managed Health Care

Managed health care was developed as a way to provide affordable, comprehensive, prepaid health care services to __________.

Correct Answer
verified

The Amendment to the HMO Act of 1973 allowed federally qualified HMOs to permit members to __________.

Correct Answer
verified

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
verified

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
verified

Which involves arranging appropriate health care services for the patient who is being released from an inpatient hospitalization?

Correct Answer
verified

Accreditation organizations develop standards that are reviewed during an evaluation process that is conducted both offsite and onsite. The evaluation process is called a(n) __________.

Correct Answer
verified

Which is associated with contracted health care services that are delivered to subscribers by individual physicians in the community?

Correct Answer
verified

Which type of HMO contracts health services that are delivered to subscribers by physicians who remain in their own office settings?

Correct Answer
verified

A management service organization (MSO) is usually owned by physicians or a hospital and provides practice management (administrative and support) services to __________.

Correct Answer
verified

A triple option plan is also called a __________ or flexible benefit plan because of the different benefit plans and extra coverage options provided through the insurer or third-party administrator.

Correct Answer
verified

Correct Answer
verified

Which is a review for medical necessity of inpatient care prior to the patient's admission?

Correct Answer
verified

Which is a private, not-for-profit organization that assesses the quality of managed care plans in the United States and releases the data to the public for consideration when selecting a managed care plan?

Correct Answer
verified

The National Committee for Quality Assurance (NCQA) reviews managed care plans and develops report cards to __________.

Correct Answer
verified

Exam 3: Managed Health Care

Managed health care was developed as a way to provide affordable, comprehensive, prepaid health care services to __________.

Correct AnswerverifiedShow Answer

The Amendment to the HMO Act of 1973 allowed federally qualified HMOs to permit members to __________.

Correct AnswerverifiedShow Answer

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 AnswerverifiedShow Answer

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 AnswerverifiedShow Answer

Which involves arranging appropriate health care services for the patient who is being released from an inpatient hospitalization?

Correct AnswerverifiedShow Answer

Accreditation organizations develop standards that are reviewed during an evaluation process that is conducted both offsite and onsite. The evaluation process is called a(n) __________.

Correct AnswerverifiedShow Answer

Which is associated with contracted health care services that are delivered to subscribers by individual physicians in the community?

Correct AnswerverifiedShow Answer

Which type of HMO contracts health services that are delivered to subscribers by physicians who remain in their own office settings?

Correct AnswerverifiedShow Answer

A management service organization (MSO) is usually owned by physicians or a hospital and provides practice management (administrative and support) services to __________.

Correct AnswerverifiedShow Answer

A triple option plan is also called a __________ or flexible benefit plan because of the different benefit plans and extra coverage options provided through the insurer or third-party administrator.

Correct AnswerverifiedShow Answer

Correct AnswerverifiedShow Answer

Which is a review for medical necessity of inpatient care prior to the patient's admission?

Correct AnswerverifiedShow Answer

Which is a private, not-for-profit organization that assesses the quality of managed care plans in the United States and releases the data to the public for consideration when selecting a managed care plan?

Correct AnswerverifiedShow Answer

The National Committee for Quality Assurance (NCQA) reviews managed care plans and develops report cards to __________.

Correct AnswerverifiedShow Answer

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