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Healthcare Multiple Choice Questions




Question;1)The managed care phenomenon was welcomed mostly by a.employers b.workers c.private insurance d.the government2) With the growth of managed care, the balance of power in the medical marketplace swung towarda.providers b.the supply side c.the demand sided.more regulation3) A managed care organization functions like a.a provider insurer c.a regulator d.a financier4) What is the purpose of risk sharing with providers? a.It makes providers immune to costs b.It makes providers cost conscious c.It rewards providers for qualityd.It keeps insurance premiums low5)Capitation is best described as a.monthly lump sum payment regardless of utilizationb.monthly lump sum payment regardless of cost c.per member per month paymentd.payments capped to a maximum cost for delivering services6)Under capitation, risk is shifted a.from the insured to the employer b.from the provider to the MCO c.from the employer to the MCOd.from the MCO to the provider7) Under which payment method is a fee schedule used? a.prospective payment b.capitation c.discounted fees d.fee for service8)The HMO Act of 1973 required care providers to contract with HMOs b.managed care organizations to offer HMO alternatives c.insurers to switch to managed care d.employers to offer an HMO alternative to conventional health insurance9)In the term, managed care, 'manage' refers to of utilization of premiums of risk of the supply of services10)Under the fee-for-service system, providers had the incentive to a.deliver more services than what would be medically necessary because a greater volume would increase their incomes b.use less technology because they could increase their incomes by not using costly procedures c.indiscriminate cost increases because they could get paid whatever they would charge d.increase the level of quality in order to attract more patients11)In the beginning, why did HMOs only had limited appeal? a.HMOs faced resistance from employers b.The shadow pricing practices used by HMOs were declared illegal c.The HMOs had only limited ability to control costs. d.The insured wanted to maintain the choice of providers12)Closed-panel plan. a.No new physicians can be added to the plan b.New enrollees are not accepted by the plan c.The enrollee cannot switch from one plan to another d.The enrollee is restricted to the providers on the panel13)Gatekeeping heavily depends on the services of a a.primary care physician manager c.disease consultant d.nurse practitioner14)Gatekeeping emphasizes a.denial of specialized services b.closed-panel utilization c.preventive and primary care d.secondary care15)Under _____ a primary care physician becomes the portal of entry to the health care delivery system. management b.utilization review c.gatekeeping d.closed-panel utilization16)Cost-effective management of care for patients who have complex medical conditions. a.Case management b.Gatekeeping c.Utilization managementd.Managed care17)A primary care physician decides whether or not to refer a patient to a specialist. a.Preauthorizationb.Prospective utilization review c.Disease management d.Closed-panel utilization18)Precertification is the responsibility of a.the gatekeeper b.the case manager c.the health plan d.the employer19)Under prospective utilization review, if a case is determined to be potentially complex and costly, it is referred management b.concurrent utilization review c.appropriate specialists d.discharge planners20)Concurrent UR in a hospital will be primarily concerned with the a.disease process b.length of stay c.preauthorizations d.quality management21)Closely associated with concurrent UR is the function of a.preauthorizationb.rehabilitation c.practice profiling d.discharge planning22)Review of patterns of practice is undertaken as part of a.concurrent utilization review b.retrospective utilization review c.prospective utilization review management23)Data collection and statistical analysis are often part of a.concurrent utilization review b.retrospective utilization review c.prospective utilization review management24)Monitoring of provider-specific practice patterns. a.concurrent utilization review b.retrospective utilization review management d.practice profiling25)When an MCO adopts capitation as the primary method of payment, which service is likely to be carved out? a.Specialty care b.Gatekeeping c.Mental health d.Primary care26)Physicians are employees of the HMO. a.Preferred providers b.IPA model c.Staff model d.Independent practice association27)Which HMO model is likely to provide the greatest control over the practice patterns of physicians? a.Staff model b.Group model c.Network model d.IPA model28)In which HMO model is the choice of physicians likely to be most restricted?a.Staff model b.Group model c.Network model d.IPA model29)Which HMO model is likely to require heavy capital outlays to expand into new markets?a.Staff model b.Group model c.Network model d.IPA model30)Who employs the physicians in the group practice model? a.The HMO b.The group practice c.The IPA d.The PPO31)A network model HMO a.employs its own network of physiciansb.exclusively uses the services of an independent practice association c.owns a network of physicians and hospitals d.contracts with more than one group practices32)Which model of HMO was specifically included in the HMO Act of 1973? a.Staff model b.Group model c.Network model d.IPA model33)Under which model is an HMO relieved of the burden to establish contracts with providers and monitor utilization? a.Staff model b.Group model c.Network model d.IPA model34)Who is likely to bear the most financial risk under the IPA model? a.The IPA b.The providers c.The HMO d.The employers35)Among HMOs, which model is predominant in the marketplace? a.Staff model b.Group model c.Network model d.IPA model36)PPOs were created by ____ in response to HMOs' growing market share. a.physicians companies c.hospitalsd.independent contractors37)PPOs differentiated themselves by offering _____ options to enrollees. a.point of service out-of-pocket payment d.discount38)A hybrid between an HMO and a PPO. a.Point-of-service plansb.Mixed model HMO c.IPA d.Exclusive provider plans39)Which type of MCO has achieved the greatest success in member enrollment? a.HMOs b.PPOs c.POS plans d.Exclusive provider plans40)How are employers coping with the rising cost of health insurance premiums? a.They are dropping health benefits in large numbers b.They are enrolling a greater number of their employees into HMOs c.They are shifting costs to their employees d.They are switching to high-deductible health plans in large numbers41)Which legislation was mainly responsible for giving states the authority to enroll a large number of Medicaid recipients into managed care? a.Tax Equity and Fiscal Responsibility Act of 1982 b.Balanced Budget Act of 1997 c.HMO Act of 1973 d.Deficit Reduction Act of 200542)Which legislation was mainly responsible for the decline of Medicare enrollments in managed care after a rise in enrollments? a.Tax Equity and Fiscal Responsibility Act of 1982 b.Balanced Budget Act of 1997 c.Medicare Prescription Drug, Improvement, and Modernization Act of 2003 d.Deficit Reduction Act of 200543)The Newborns' and Mothers' Health Protection Act of 1996 prohibits a health plan to offer less than _____ of inpatient stay following a normal vaginal delivery. a.24 hours b.48 hoursc.3 days d.4 days44)The Newborns' and Mothers' Health Protection Act of 1996 prohibits a health plan to offer less than _____ hours of inpatient stay following a Caesarean section. a.48 b.72 c.96 d.12045)Which of the following is not an example of consolidation? a.Building of new facilities b.Acquiring an existing facility c.Merging with an existing organization d.Alliances among existing organizations46)Which of these organizations was specifically created to bring management expertise to physician group practices? a.Virtual organizations b.Physician-hospital organizations c.Provider-sponsored organizations d.Management services organizations47)An organization ceases to exist as a separate entity and is absorbed into the purchasing corporation. a.Acquisition b.Merger c.Joint venture d.Alliance48)Two organizations cease to exist, and a new corporation is formed. a.Acquisition b.Merger c.Joint venture d.Alliance49)A new corporation created by two partnering organizations remains independent.a.Acquisition b.Merger c.Joint venture d.Alliance50)A type of integration that does not involve any joint ownership of assets. a.Acquisition b.Merger c.Joint venture d.Alliance51)What type of integration is represented by a chain of nursing homes? a.Vertical integration b.Networkc.Horizontal integration d.Diversification52)Regional health systems are often a.horizontally integrated b.vertically integrated c.formed into virtual organizations d.formed into alliances53)Antitrust legislation is intended to provide checks against a.anticompetitive behavior b.fraud and abusec.self-referral of patients d.payments for patient referrals


Paper#58574 | Written in 18-Jul-2015

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