HCM 450 QUIZ 10 | QUESTIONS AND ANSWERS | 2026
UPDATE | 100% CORRECT
What is the primary purpose of utilization management?
Reduce fraudulent billing practices
Eliminate under- and overuse of health services
Stop patient dissatisfaction and high costs
Expand formation of accountable care organizations Answer - Eliminate under-
and overuse of health services
Which of the following factors is NOT considered when determining the
medical necessity of a healthcare service?
Scientific evidence supporting use of the service
Convenience of the patient or the provider
Cost-effectiveness of the service or the alternatives
Potential benefits and harms to the patient Answer - Convenience of the
patient or the provider
, What source document is used to identify medically necessary services?
Insurance benefits booklet
Medicare Conditions of Participation
Physician orders
Clinical practice guidelines Answer - Clinical practice guidelines
What job aid can be used to remind physicians and other caregivers of key
interventions on each day of a patient's hospitalization?
Standard orders
Storyboard
Flowchart
Clinical path Answer - Clinical path
Which of the following situations is an example of prospective utilization
review?
Health plan evaluates the medical necessity of a member's upcoming surgery.
UPDATE | 100% CORRECT
What is the primary purpose of utilization management?
Reduce fraudulent billing practices
Eliminate under- and overuse of health services
Stop patient dissatisfaction and high costs
Expand formation of accountable care organizations Answer - Eliminate under-
and overuse of health services
Which of the following factors is NOT considered when determining the
medical necessity of a healthcare service?
Scientific evidence supporting use of the service
Convenience of the patient or the provider
Cost-effectiveness of the service or the alternatives
Potential benefits and harms to the patient Answer - Convenience of the
patient or the provider
, What source document is used to identify medically necessary services?
Insurance benefits booklet
Medicare Conditions of Participation
Physician orders
Clinical practice guidelines Answer - Clinical practice guidelines
What job aid can be used to remind physicians and other caregivers of key
interventions on each day of a patient's hospitalization?
Standard orders
Storyboard
Flowchart
Clinical path Answer - Clinical path
Which of the following situations is an example of prospective utilization
review?
Health plan evaluates the medical necessity of a member's upcoming surgery.
