Casciani HCMN 415 Fall 2007 Final[1]

Casciani HCMN 415 Fall 2007 Final[1] - HCMN 415 Fall 2007...

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HCMN 415 Fall 2007 Final Examination Due VIA EMAIL no later than 9am, DECEMBER 14 Professor Casciani Download this exam and type your responses directly into the document . No handwritten exams will be accepted. You must email the completed exam back to me by the deadline. SECTION I – MULTIPLE CHOICE (2 points each) 1. In what model does an HMO contract with more than one group practice to provide medical services to its members? a. group model b. staff model c. network model d. IPA model Answer: ___C_ 2. Which organization(s) need a Corporate Compliance Officer (CCO)? a. health plans with a Medicare+Choice risk contract b. every organization that provides health care c. hospitals d. all of the above e. a and c Answer: __E___ 3. What are the basic ways to compensate open-panel PCPs? a. capitation b. DRGs c. fee-for-service d. a and c only e. all of the above Answer: ___D__ 4. Carve-outs can be defined as: a. stop-loss reinsurance provisions b. risk/bonus arrangements within capitation c. services billable outside of a capitation payment d. per diem rates Answer: ___C__
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5. A common risk arrangement used as a performance-based incentive is: a. carve-outs b. withholds c. per diem d. FFS Answer: __B___ 6. Capitation is a payment method used by HMOs because: a. it eliminates the FFS incentive to overutilize b. costs are predictable c. it is less costly to administer than FFS d. a and c only e. all of the above Answer: ___E__ 7. A variation of FFS reimbursement that encompasses all services delivered in an episode of care is referred to as: a. resource-based relative value scale b. global fee c. performance-based FFS d. capitation Answer: __B___ 8. Which of the following standardized measures for quality of care is commonly used for M+C organizations? a. HEDIS b. TQM c. SERVQUOL d. QOI Answer: ___A__ 9. Which of the following can be considered as the largest covered group of the Medicaid program? a. persons who are low income with minor children b. persons who are poor and aged c. persons who are in nursing homes or specialized facilities d. persons who are poor and disabled Answer: __A___ 10. Which of the following does HIPAA regulate? a. electronic communications between payors and providers
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b. portability and access standards c. guaranteed renewability of group coverage d. all of the above Answer: __D___ 11. Which of the following regulation requires HMOs to have an internal system that identifies opportunities to improve care, measures the performance of participating providers, and conducts peer review activities? a. Utilization Review Model Act b. Health Care Professional Credentialing Verification Model Act c. NAIC Quality Assessment and Improvement Model Act d. none of the above Answer: ___D__ 12. Which of the following specialty categories is never included as a “direct access” provider to HMO patients? a. OB/GYN
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Casciani HCMN 415 Fall 2007 Final[1] - HCMN 415 Fall 2007...

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