Casciani HCMN 415 Fall 2007 Midterm

Casciani HCMN 415 Fall 2007 Midterm - HCMN 415 Fall 2007...

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HCMN 415 Fall 2007 Midterm Examination Due VIA EMAIL no later than 9am, NOVEMBER 2 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. The integral components of managed care are: Answer: __E__ a. wellness and prevention b. primary care orientation c. utilization management d. a and c only e. all of the above 2. Managed care is best described as: Answer: _B___ a. an insurance company that provides health services b. a broad and constantly changing array of health plans that attempt to manage both cost and quality of care c. an inexpensive form of payment of health services 3. Capitation is usually defined as: Answer: __A__ a. prepayment for services on a fixed, per member per month basis b. fee-for-service including withhold provisions c. performance based compensation system d. stop-loss reinsurance provisions 4. Advantages of an IPA include: Answer: _E___ a. broader physician choice for members b. more convenient geographic access c. requires less start-up capital d. a and b only e. all of the above 5. This federal law has established specific, enforceable regulations regarding the standardization of electronic transactions and code sets for procedures and diagnoses. a. OCR Answer: _C___ b. HEDIS c. HIPAA d. EMTALA
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The factor that changes the most from physician training to practice in a managed care organization is: Answer: _D___ a. quality standards b. degree of autonomy c. performance feedback d. none of the above 7. This agency has had the largest impact on the quality provided by MCOs. a. JCAHO Answer: __A__ b. HEDIS c. AAMPA d. NCQA 8. The least appropriate site for disease management is: Answer: _B___ a. ambulatory care settings b. inpatient settings c. outreach clinics d. none of the above 9. The Health Plan Employer Data and Information Set (HEDIS) is a measurement tool used by about _______ of all health plans. Answer: _A___ a. 90% b. 67% c. 3% d. 48% 10. Member services is responsible for all of the following activities, except which one? a. providing information to members Answer: _C_ b. handling member grievances and complaints c. enhancing the relationship between the members of the plan and the plan itself. d. adjudicating claims 11. Perhaps the most difficult task of the MCO’s medical director is: Answer: _C_ a. dealing with difficult and noncompliant physicians b. determining appropriate levels of medical care c. managing staff d. none of the above 12. _________________ is the primary revenue source for HMOs. Answer: _D a. investments b. equity financing c. withholds d. premium revenue 13. Under the HMO Model Act, emergency care should be provided ______ hours a day. a.
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This note was uploaded on 05/15/2008 for the course HCMN 415 taught by Professor Casciani during the Fall '08 term at Towson.

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Casciani HCMN 415 Fall 2007 Midterm - HCMN 415 Fall 2007...

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