Question 1

Which of the following is true of an exclusive provider organization (EPO) ?

Accepted Answer

A)   It is regulated under insurance statutes.
B)   It is regulated under federal and state health maintenance organization (HMO)  regulations.
C)   Premiums are lower than with a health maintenance organization (HMO) .
D)   Premiums are higher than with a preferred provider organization (PPO) .

Question 2

The purpose of a withhold program is to:

Accepted Answer

A)   encourage providers to use cost-effective methods.
B)   reward physicians for ordering extensive tests.
C)   discourage preventive care.
D)   promote the use of specialty physicians.

Question 3

The type of insurance that provides coverage for a designated period of time is:

Accepted Answer

A)   medical insurance.
B)   special risk.
C)   short-term health insurance.
D)   long-term care.

Question 4

All health insurance contracts define medical necessity in the same way.

Accepted Answer

A) True 
 B)False

Question 5

Match the following
-The type of insurance that covers both medical and custodial services

Accepted Answer

A)   individual practice association (IP
A)   health maintenance organization (HMO) 
B)   staff model health maintenance organization (HMO) 
C)   major medical insurance
D)   outpatient insurance
E)   open access health maintenanceF)  exclusive provider organization (EPO) G)  point-of-service (POS)  planH)  network model health maintenance organization (HMO) I)  long-term care insuranceJ)  preferred provider organization (PPO)

Question 6

The most restrictive type of managed care plan is the:

Accepted Answer

A)   exclusive provider organization (EPO) .
B)   health maintenance organization (HMO) .
C)   individual practice association (IP
A)  .
D)   preferred provider organization (PPO) .

Question 7

The type of insurance coverage that provides protection against a specific type of accident or illness is:

Accepted Answer

A)   outpatient.
B)   major medical.
C)   special risk.
D)   catastrophic health insurance.

Question 8

Which is true regarding health reimbursement arrangements (HRAs) ?

Accepted Answer

A)   unused reimbursements cannot be accessed.
B)   participation ends upon termination of employment.
C)   expenses must have incurred during the coverage period.
D)   the funds cannot be used for dental and vision care.

Question 9

Features of a preferred provider organization (PPO)  include which of the following? (Select all that apply)

Accepted Answer

A)   It contracts with healthcare providers to form a network.
B)   It offers members financial incentives to use network providers.
C)   It usually rewards providers for managing the cost of care.
D)   It employs salaried physicians who treat members in facilities it owns and operates.

Question 10

A physician who coordinates a patient's care and refers patients to specialists is a(n) :

Accepted Answer

A)   preferred provider physician (PPP) .
B)   referring gatekeeper.
C)   primary care physician (PCP) .
D)   primary physician coordinator (PP
C)  .

Question 11

A characteristic of a staff model health maintenance organization (HMO)  is that it:

Accepted Answer

A)   contracts with a multispecialty physician group.
B)   is a decentralized healthcare delivery system.
C)   employs salaried physicians.
D)   agrees to contractual discounts with physicians.

Question 12

An exclusive provider organization (EPO)  is similar to a preferred provider organization (PPO)  because they both have:

Accepted Answer

A)   a limited provider network.
B)   gatekeepers.
C)   payment by capitation.
D)   a flexible benefit design.

Question 13

If a physician has ordered surgery for a patient, a managed care organization (MCO) case manager may disallow an inpatient stay if the MCO guidelines designate the procedure as best suited for outpatient care.

Accepted Answer

A) True 
 B)False

Question 14

Which is true regarding a flexible spending account (FSA) ?

Accepted Answer

A)   The money deducted is subject to taxes.
B)   The money can be withdrawn without penalty.
C)   Funds are lost when the plan year is over.
D)   It is used exclusively as a managed care plan.

Question 15

The type of health maintenance organization (HMO)  plan that employs salaried physicians who treat members in facilities owned and operated by the HMO is a(n) :

Accepted Answer

A)   group model.
B)   individual practice association (IP
A)   model.
C)   network model.
D)   staff model.

Question 16

In a managed care organization (MCO) , a primary care physician (PCP)  is any of the following EXCEPT:

Accepted Answer

A)   general practitioner.
B)   family practitioner.
C)   dermatologist.
D)   internal medicine doctor.

Question 17

The subscriber in a health maintenance organization (HMO)  can also be called a(n) :

Accepted Answer

A)   employer or policyholder.
B)   policyholder or member.
C)   member or provider.
D)   patient or carrier.

Question 18

Which of the following is true of managed care contracts with providers?

Accepted Answer

A)   They are irrevocable by the provider.
B)   They are irrevocable by the managed care organization (MCO) .
C)   They are usually 1-year contracts.
D)   Providers must provide a 1-year notice to cancel the contract.

Question 19

Match the following
-This type of insurance provides protection for emergency department visits and other outpatient divisions in a hospital or medical facility.

Accepted Answer

A)   individual practice association (IP
A)   health maintenance organization (HMO) 
B)   staff model health maintenance organization (HMO) 
C)   major medical insurance
D)   outpatient insurance
E)   open access health maintenanceF)  exclusive provider organization (EPO) G)  point-of-service (POS)  planH)  network model health maintenance organization (HMO) I)  long-term care insuranceJ)  preferred provider organization (PPO)

Question 20

What is the HMO Act of 1973?

Accepted Answer

The HMO Act was signed into la...

Exam 2: Understanding Managed Care: Insurance Plans

A physician who coordinates a patient's care and refers patients to specialists is a(n) :

Correct AnswerverifiedShow Answer

Which is true regarding a flexible spending account (FSA) ?

Correct AnswerverifiedShow Answer

The type of insurance coverage that provides protection against a specific type of accident or illness is:

Correct AnswerverifiedShow Answer

Features of a preferred provider organization (PPO) include which of the following? (Select all that apply)

Correct AnswerverifiedShow Answer

Match the following -The type of insurance that covers both medical and custodial services

Correct AnswerverifiedShow Answer

A characteristic of a staff model health maintenance organization (HMO) is that it:

Correct AnswerverifiedShow Answer

All health insurance contracts define medical necessity in the same way.

Correct AnswerverifiedShow Answer

The most restrictive type of managed care plan is the:

Correct AnswerverifiedShow Answer

The type of insurance that provides coverage for a designated period of time is:

Correct AnswerverifiedShow Answer

If a physician has ordered surgery for a patient, a managed care organization (MCO) case manager may disallow an inpatient stay if the MCO guidelines designate the procedure as best suited for outpatient care.

Correct AnswerverifiedShow Answer

In a managed care organization (MCO) , a primary care physician (PCP) is any of the following EXCEPT:

Correct AnswerverifiedShow Answer

Match the following -This type of insurance provides protection for emergency department visits and other outpatient divisions in a hospital or medical facility.

Correct AnswerverifiedShow Answer

The subscriber in a health maintenance organization (HMO) can also be called a(n) :

Correct AnswerverifiedShow Answer

The purpose of a withhold program is to:

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What is the HMO Act of 1973?

Correct AnswerverifiedThe HMO Act was signed into la...View AnswerShow Answer

An exclusive provider organization (EPO) is similar to a preferred provider organization (PPO) because they both have:

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Which of the following is true of managed care contracts with providers?

Correct AnswerverifiedShow Answer

Which of the following is true of an exclusive provider organization (EPO) ?

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The type of health maintenance organization (HMO) plan that employs salaried physicians who treat members in facilities owned and operated by the HMO is a(n) :

Correct AnswerverifiedShow Answer

Which is true regarding health reimbursement arrangements (HRAs) ?

Correct AnswerverifiedShow Answer

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The HMO Act was signed into la...
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