HIT 235 Midterm - Chapters 1-5 HIMT 2350
2019 Exam Latest Update
True - ANSWER All parts of Medicare include a cost sharing provision.
All of the above - ANSWER Which of the following types of care represents
healthcare services delivered by MCO's?
Applying PMPM payment system - ANSWER All of the following functions are
ways that MCO's work toward their goal of quality patient care EXCEPT:
Physicians' personal clinical experiences - ANSWER Evidence based clinical
guidelines originate from all of the following sources EXCEPT:
All of the above - ANSWER For what reasons do MCO's survey their members for
feedback?
Administrative review - ANSWER All of the following activities are steps in
medical necessity and utilization review EXCEPT:
Refer patients to colleagues for immunization and other general care - ANSWER
All of the following actions reflect the roles of PCP's in MCO's EXCEPT:
Applying episode of care payment system - ANSWER All of the following
activities are service management tools used in controlling costs EXCEPT:
True - ANSWER Disease management is closely associated with coordination of
care tools of MCO's because efforts of multiple providers must be synchronized
in disease management.
True - ANSWER Episode of care management includes capitated reimbursement
and global payment.
All of the above - ANSWER Which of the following activities do MCO's use as
financial incentives to control costs?
Immunizations and well baby care - ANSWER All of the following types of
services or populations are common examples of carve outs EXCEPT:
POS - ANSWER Which type of MCO allows patients to choose how they will
receive services at the time that the patients need the service?
, Solo physician practices - ANSWER All of the following types of organizations
represent ways of intergrating health organizations EXCEPT:
All of the above - ANSWER Access to mental or behavioral health or medical
specialists is through referral; what is the term for the individual who makes the
referral?
Utilization review - ANSWER What is the term that means evaluating, for a
healthcare service, the appropriateness of its setting and its level of service?
Well baby check - ANSWER All of the following services are typically reviewed
for medical necessity and utilization EXCEPT:
Workers compensation - ANSWER For what type of care should the physician
practice manager expect to work with a case manager?
Links to electronic banking - ANSWER All of the following are elements of
prescription management EXCEPT:
Release summaries of the financial incentives - ANSWER A patient, who was a
medicaid recipient, asked about the types of financial incentives that the MCO
used; what should the MCO's administrator do?
To encourage the delivery of affordable, quality healthcare - ANSWER Why did
Congress pass the Health Maintenance Organization Act of 1973?
Staff model - ANSWER In which type of HMO are the physicians employees?
The patients out of pocket costs will be increased - ANSWER The patient
belongs to a managed car plan; the patient wants to make an appointment with
an out of network specialists; the plan has approved the appointment as out of
network; what should the patient expect?
Medicare Advantage - ANSWER What is the term for an MCO that serves
Medicare beneficiaries?
Individuals who are eligible for Medicare and Medicaid - ANSWER Who are dual
eligibles?
Intergrated delivery system - ANSWER What term means a network of
organizations that directly provides or arranges to provide a coordinated
continuum of services to a defined population and takes accountability for the
cost, quality, and outcomes of care?
2019 Exam Latest Update
True - ANSWER All parts of Medicare include a cost sharing provision.
All of the above - ANSWER Which of the following types of care represents
healthcare services delivered by MCO's?
Applying PMPM payment system - ANSWER All of the following functions are
ways that MCO's work toward their goal of quality patient care EXCEPT:
Physicians' personal clinical experiences - ANSWER Evidence based clinical
guidelines originate from all of the following sources EXCEPT:
All of the above - ANSWER For what reasons do MCO's survey their members for
feedback?
Administrative review - ANSWER All of the following activities are steps in
medical necessity and utilization review EXCEPT:
Refer patients to colleagues for immunization and other general care - ANSWER
All of the following actions reflect the roles of PCP's in MCO's EXCEPT:
Applying episode of care payment system - ANSWER All of the following
activities are service management tools used in controlling costs EXCEPT:
True - ANSWER Disease management is closely associated with coordination of
care tools of MCO's because efforts of multiple providers must be synchronized
in disease management.
True - ANSWER Episode of care management includes capitated reimbursement
and global payment.
All of the above - ANSWER Which of the following activities do MCO's use as
financial incentives to control costs?
Immunizations and well baby care - ANSWER All of the following types of
services or populations are common examples of carve outs EXCEPT:
POS - ANSWER Which type of MCO allows patients to choose how they will
receive services at the time that the patients need the service?
, Solo physician practices - ANSWER All of the following types of organizations
represent ways of intergrating health organizations EXCEPT:
All of the above - ANSWER Access to mental or behavioral health or medical
specialists is through referral; what is the term for the individual who makes the
referral?
Utilization review - ANSWER What is the term that means evaluating, for a
healthcare service, the appropriateness of its setting and its level of service?
Well baby check - ANSWER All of the following services are typically reviewed
for medical necessity and utilization EXCEPT:
Workers compensation - ANSWER For what type of care should the physician
practice manager expect to work with a case manager?
Links to electronic banking - ANSWER All of the following are elements of
prescription management EXCEPT:
Release summaries of the financial incentives - ANSWER A patient, who was a
medicaid recipient, asked about the types of financial incentives that the MCO
used; what should the MCO's administrator do?
To encourage the delivery of affordable, quality healthcare - ANSWER Why did
Congress pass the Health Maintenance Organization Act of 1973?
Staff model - ANSWER In which type of HMO are the physicians employees?
The patients out of pocket costs will be increased - ANSWER The patient
belongs to a managed car plan; the patient wants to make an appointment with
an out of network specialists; the plan has approved the appointment as out of
network; what should the patient expect?
Medicare Advantage - ANSWER What is the term for an MCO that serves
Medicare beneficiaries?
Individuals who are eligible for Medicare and Medicaid - ANSWER Who are dual
eligibles?
Intergrated delivery system - ANSWER What term means a network of
organizations that directly provides or arranges to provide a coordinated
continuum of services to a defined population and takes accountability for the
cost, quality, and outcomes of care?
