Window Help ew Assessment Homework Help - Q&A from Or X + elearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 111 minutes remaining 50 OF 50 QUESTIONS REMAINING Question 20 2 Points Under the ACA, each state has expanded their Medicaid eligibility criteria. A) True B False Question 21 2 Points Member services is responsible for all of the following activities, except: A Providing information to members B Handling member grievances and complaints Enhancing the relationship between the members of the plan and the plan itself. D Adjudicationg claims E) Monitoring fraud, waste, and abuse Question 22 2 Points APR 1 astv 4 MacBook Air DD 20 DII F5 F9 F1 F2 F3 F4 F6 F7 F8 @ % & # 3 5 9 NView Assessment Homework Help - Q&A from Or x elearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 110 minutes remaining 50 OF 50 QUESTIONS REMAINING Question 42 2 Points Medicare Advantage plans are authorized under Part D. A True B False Question 43 2 Points Medicare is provided without cost to the Medicare beneficiary. A True B False Question 44 2 Points One potential negative consequence of drug formularies with high copayments is: A) Increased use of generic drugs. 1 tv 4 MacBook Air 20 888 DII F1 F3 F4 F5 F6 F7 F 8 # $ % & W 4 5 6elearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 110 minutes remaining 50 OF 50 QUESTIONS REMAINING Question 48 2 Points Utilization management seeks to reduce practice variation while promoting good outcomes and"_ A reducing access B reducing costs increasing patients none of the above Question 49 2 Points Hospital utilization varies by geographical area. A) True B False Question 50 2 Points 0 14 0 11 APR TO 1 tv 4 MacBook Air 20 888 DII F1 F2 F3 F4 F5 F6 F7 F 8 # N 4 5 6 8File Edit View History Bookmarks Profiles Tab Window Help View Assessment *Homework Help - Q&A from Or x elearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 9 112 minutes remaining 50 OF 50 QUESTIONS REMAINING Question 9 2 Points DUR is the acronym for: A Drug Utility Role B Drug Utilization Review C Drugs Under Research D Drug Unknown Request Question 10 2 Points UM encompasses 3 types of clinical reviews/activities: A Present, Future, and Past Reviews B Inside, Outside, and Around Reviews C Current, Internal, and External Reviews D Prospective, Concurrent, and Retrospective Reviews 1 as tv 4 MacBook Air :9.- 20 868 DII F1 F2 F3 F4 F5 F6 F7 F8 @ $ % & N 3 5 6View Assessment Homework Help - Q&A from Or X elearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 111 minutes remaining 50 OF 50 QUESTIONS REMAINING Question 26 2 Points Which of the following organizations have developed accreditation programs for managed care organizations? A NCQA URAC C AAAHC D All of the above Question 27 2 Points Claims review is an example of: A Prospective Review B Retrospective Review C Concurrent Review D Discharge Planning Review APR 1 tv MacBook Air 80 808 DII DO F1 F2 F3 F4 F5 F6 F7 F 8 # $ % & N 5 6 9ew Assessment *Homework Help - Q&A from Or X elearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 111 minutes remaining 50 OF 50 QUESTIONS REMAINING Question 15 2 Points Medicaid is enabled as a FFS system, so states must first obtain a federal waiver if they want use managed care for their Medicaid program. A True False Question 16 2 Points All the states require PPOs to be accredited. A) True B False Question 17 2 Points ERISA and the ACA both require expedited review for benefits determinations involving urgent medical care. 1 tv 4 MacBook Air 20 DII F1 F2 F3 F4 F5 F6 F7 F8 # % 2 4 5 6 8 9 WEdit View History Bookmarks Profiles Tab Window Help File View Assessment X *Homework Help - Q&A from Or x elearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 112 minutes remaining 50 OF 50 QUESTIONS REMAINING Exam Content This Final Exam is taken from Chapters 5 to 8. There are 50 multiple choice and true/false questions and you have 2 hours to take this exam. And you have only one attempt to take it. Good luck ! Question 1 2 Points "Any Willing Provider" Law requires payment for emergency room visit care if a non-clinical person is convinced that a true emergency existed A True B False Question 2 2 Points Accreditation is: A A not for profit organization B A Medical Savings Account APR 11 8 8 1 MacBook Air C 20 888 DII F1 F2 F3 F4 F5 F6 F7 FB # $ % 2 5 6View Assessment X *Homework Help - Q&A from Or x + elearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 111 minutes remaining 50 OF 50 QUESTIONS REMAINING Question 13 2 Points Which of the following electronic transactions is not standardized under HIPAA? A Claims Authorizations C Payments to providers D Enrollment E) Electronic medical records Question 14 2 Points IBNR stands for which of the following? A Interest-Bearing Non-Revocable Assets Investment Board Non-Binding Notices C Incurred But Not Reported (D ) Investments Based on Normalized Revenues 1 MacBook Air 20 DII F1 62 F3 F4 F5 F6 F7 F8 % & W # 4 5 6 8View Assessment X Homework Help - Q&A from Or x + elearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 110 minutes remaining 50 OF 50 QUESTIONS REMAINING Question 40 2 Points Which of the following federal agencies is not involved in regulating health benefits plans? A Department of Health and Human Services (DHHS) B Department of Homeland Security (DHS) C Department of Defense (DOD) D Department of the Treasury E Department of the Interior Question 41 2 Points Which of the following is not a federal law affecting health insurance, health benefits plans, or HMOs? A) COBRA B ERISA C CSNY D HIPAA 1 itv 4 MacBook Air 20 DII F1 F2 F3 F4 F5 F6 F7 F8 # $ % 2 3 4 5 6 8he File Edit View History Bookmarks Profiles Tab Window Help View Assessment X *Homework Help - Q&A from Or X + elearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 112 minutes remaining 50 OF 50 QUESTIONS REMAINING Question 5 2 Points A drug formulary generally will not contain: A) All available drugs for each medical condition B Drugs manufactured outside of the United States C) Frequently prescribed drugs D Effective, inexpensive drugs for a specific medical condition Question 6 2 Points HEDIS is: A NCQA's industry standards for reporting data B Pre-payment to providers in anticipation of discontinuing services C Reward to patients for selecting specific primary care physicians D Reward to PCPs for not utilizing physician specialists 1 4 . MacBook Air 20 988 DII F1 F2 F3 F4 F 5 F6 F7 F8 # % & 3 5 6 8 9 Nlew Assessment X Homework Help - Q&A from Or X elearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 110 minutes remaining 50 OF 50 QUESTIONS REMAINING Question 36 2 Points Who has the final responsibility for all aspects of the HMO organization? A) CEO B zoo C) CFO Board of Directors E) CMC Question 37 2 Points The 1973 Health Maintenance Organization Act: A Became a constitutional amendment under the Clinton administration. B Provided loans and other financial guarantees for HMO start up costs C Granted RNs the authority to prescribe medications without the presence of a licensed physician. D Prevented those with HMO coverage to continue their care. APR 1 istv 4 MacBook Air 20 388 DII F1 F2 F3 F4 F5 F6 F7 F8 # $ % & 4 5 6 9elearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 110 minutes remaining 50 OF 50 QUESTIONS REMAINING Question 46 2 Points Which of the following is not included in Donabedian's quality paradigm? A Outcome B Structure C Efficiency D Process Question 47 2 Points The most common measurement of inpatient admission utilization is: A members per thousand bed days per year B admissions per thousand bed days per year C encounters per thousand members per year D bed days per thousand members per year APR 1 71 tv 4 MacBook Air 20 F1 F2 F3 F4 F 5 F6 F7 F8 # $ % N 3 4 5 6 8Assessment X Homework Help - Q&A from Or x + learn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 111 minutes remaining 50 OF 50 QUESTIONS REMAINING Question 24 2 Points Which of the following are not typically considered to be marketing functions: A) Brand management Closing the sale C Market research D Advertising E Public relations Question 25 2 Points It is possible for a specialist to also act as a primary care provider? A True B False 1 4 MacBook Air DD 20 DII F8 F9 F1 F2 F3 F4 F 5 F6 F7 & # $ % 5 6 9 N 4 8ew Assessment Homework Help - Q&A from Or X elearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 110 minutes remaining 50 OF 50 QUESTIONS REMAINING Question 34 2 Points Medicare Part B covers: A Prescription drugs Inpatient services C Provider and Outpatient services D Long term home health care Question 35 2 Points Medicaid was created to provide health insurance coverage for which of the following groups: A Institutionalized (e.g. nursing home, developmentally disabled, and mental retarded) persons. B Individuals with End Stage Renal Disease. C High income individuals. D None of the above. E All of the above " tv 4 MacBook Air 20 888 D F1 F2 F3 F4 F5 F6 F7 F8 & # $ % 4 5 6 8 9Assessment Homework Help - Q&A from Or X learn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 111 minutes remaining 50 OF 50 QUESTIONS REMAINING Question 28 2 Points All managed care plans are required by the federal government to participate in accreditation and performance measurement programs. A True B False Question 29 2 Points Dependent Coverage was extended to age 29 under the Affordable Care Act (ACA) A) True B False Question 30 2 Points Enrollment and Billing errors can affect all parts of an HMO or health insurer and its customers. A) True APR T 1 11 atv M 4 MacBook Air 20 DO F1 F2 F3 F4 F 5 F6 F7 FB # $ % 2 3 4 5 6 18 9View Assessment elearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 110 minutes remaining 50 OF 50 QUESTIONS REMAINING Question 44 2 Points One potential negative consequence of drug formularies with high copayments is: A Increased use of generic drugs. B Increased use of brand drugs. C) High copayments may be a barrier to adherence. D Decreased use of the most cost-effective medications. E Decreased Shipping/Mail Order Rates Question 45 2 Points Two desirable outcomes of tiered prescription benefits design are: A Brand drug use increases and generic drug use declines B The use of less expensive generic drugs increases, and members save money by paying lower copayments C Member costs increase and brand name drug use increases D ) Members pay higher copayments and pharmacies make higher gross profit margins APR 1 71 itv A MacBook Air 20 DII F1 2 F3 F4 F5 F6 F7 F8 # $ % & 2 3 4 5 6 8Assessment * Homework Help - Q&A from Or x learn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 111 minutes remaining 50 OF 50 QUESTIONS REMAINING Question 30 2 Points Enrollment and Billing errors can affect all parts of an HMO or health insurer and its customers. A True B False Question 31 2 Points Medicare Advantage plans are authorized under Part D. A) True B False Question 32 2 Points TOM stands for: A Total Quality Maintenance Total Quality Moscuroc APR 1 4 MacBook Air DII F1 2 F3 F4 F5 F6 F7 FB % & CO 3 4 5 16lab Window Help ew Assessment Homework Help - Q&A from Or X elearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 111 minutes remaining 50 OF 50 QUESTIONS REMAINING Question 17 2 Points ERISA and the ACA both require expedited review for benefits determinations involving urgent medical care. A True B False Question 18 2 Points Medicare is provided without cost to the Medicare beneficiary. A True B) False Question 19 2 Points CMS requires MA plans to have a quality improvement program to measure program performance. A) True B False APR 1 O 71 "tv 4 MacBook Air 30 988 DII F1 F2 F3 F4 F5 F6 F7 F8 F9 # % & 5 6 8 9 N 4ew Assessment Homework Help - Q&A from Or x + elearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 111 minutes remaining 50 OF 50 QUESTIONS REMAINING A Claims B Authorizations C) Payments to providers D Enrollment E Electronic medical records Question 14 2 Points IBNR stands for which of the following? A Interest-Bearing Non-Revocable Assets B Investment Board Non-Binding Notices C Incurred But Not Reported D Investments Based on Normalized Revenues E Incurred Before Normal Reviews 1 as tv 4 MacBook Air 20 888 DII F1 F2 F3 F4 F5 F6 F7 F8 # $ % N 4 5 6 8View Assessment X Homework Help - Q&A from Or x + elearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 9 112 minutes remaining 50 OF 50 QUESTIONS REMAINING A Utilization Management B Utility Maintenance C Universal Management D Utilization Maintenance Question 12 2 Points Which of the following is not a typical function of the claims department? A Claims capture B Coordination of Benefits (COB) and Other Party Liability (OPL) (C) Determination of member eligibility on the date of service D Member enrollment E Provider payment F Adjudication APR 1 itv MacBook Air 20 DII F1 F2 F3 F4 F5 F6 F7 F8 # EA % & 5 6 9File Edit View History Bookmarks Profiles Tab Window Help View Assessment Homework Help - Q&A from Or X elearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 112 minutes remaining 50 OF 50 QUESTIONS REMAINING Question 7 2 Points When choosing a health plan for its employees, employers consider all of the following factors except: A Cost of the health plan B Degree of plan benefit coverage provided C Degree of access to network care D The Reputation of the CEO Question 8 2 Points Pharmacy Benefits Manager (PBMs) organizations manage drug/prescription utilization through: A Mail Order B DUR C Benefit Design D) All of the above 1 astv 4 MacBook Air 20 888 DII F1 F2 F3 F4 F5 F6 F7 FB @ % A & # $ N 3 4 5 6 9View Assessment X Homework Help - Q&A from Or x + elearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 9 112 minutes remaining 50 OF 50 QUESTIONS REMAINING Question 11 2 Points UM is the abbreviation for: A Utilization Management Utility Maintenance C Universal Management D Utilization Maintenance Question 12 2 Points Which of the following is not a typical function of the claims department? A) Claims capture B Coordination of Benefits (COB) and Other Party Liability (OPL) C) Determination of member eligibility on the date of service D Member enrollment E ) Provider pavment S ul 2 11 APR 1 tv MacBook Air 20 868 DII F1 F2 F3 F4 F5 F6 F7 F8 # $ % & N W 4 5 6 8me File Edit View History Bookmarks Profiles Tab Window Help View Assessment *Homework Help - Q&A from Or X elearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 9 112 minutes remaining 50 OF 50 QUESTIONS REMAINING Question 3 2 Points Which of the following factors is most likely to affect a patient's drug copayments? A Expiration dates reported by the drug manufacturers Availability of a generic version of a prescribed drug C) The total number of drugs prescribed for all patients by a single physician D The total number of physicians prescribing drugs for a single patient Question 4 2 Points The Medicaid program was created in what year? A) 1935 B 1945 C) 1955 D 1965 MacBook Air 80 DII F1 3 F4 F5 F6 F7 F8 # $ % & 5 6 8 9 NView Assessment Homework Help - Q&A from Or x elearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 110 minutes remaining 50 OF 50 QUESTIONS REMAINING E Department of the Interior Question 41 2 Points Which of the following is not a federal law affecting health insurance, health benefits plans, or HMOs? A COBRA B ERISA C) CSNY D HIPAA E) ACA Question 42 2 Points Medicare Advantage plans are authorized under Part D. A) True 1 tv M 4 MacBook Air 20 988 DII F1 2 F3 F4 F5 F6 F7 F 8 # $ % & 2 W 4 5 6 8w Assessment *Homework Help - Q&A from Or X + elearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 9 111 minutes remaining 50 OF 50 QUESTIONS REMAINING Question 22 2 Points Appeal of coverage denial reviews are a distinctly formal process governed by both state and federal laws. True B False Question 23 2 Points The most common form of claims submission is electronic. A) True B False Question 24 2 Points Which of the following are not typically considered to be marketing functions: A) Brand management 1 as tv 4 MacBook Air 20 DII DD F1 F3 F5 F6 F 8 F9 F2 F4 F7 % & # 4 5 6 8 9 N WAssessment X Homework Help - Q&A from Or X earn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 110 minutes remaining 50 OF 50 QUESTIONS REMAINING Question 32 2 Points TOM stands for: A Total Quality Maintenance Total Quality Measures C Transitional Quality Measurement D Transitional Quality Maintenance E Total Quality Management Question 33 2 Points Medicare Part D covers: A) Prescription drugs B Inpatient services (C) Provider and Outpatient services D Long term home health care 1 attv 4 MacBook Air 888 DII DD F1 F5 F6 F7 F8 F9 F2 F3 F4 # $ % 3 4 5 6 8 9 Nelearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 50 OF 50 QUESTIONS REMAINING 110 minutes remaining Hospital utilization varies by geographical area. A True B False 2 Points Question 50 UM works by telling doctors and hospitals what to do. A True B False Additional content You can add text, images, and files here. 1 O tv M MacBook Air 20 868 DII F1 F2 F3 F4 F 5 F6 F7 F8 % & # $ N 3 4 5 6View Assessment elearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 110 minutes remaining 50 OF 50 QUESTIONS REMAINING A Increased use of generic drugs. B Increased use of brand drugs. C High copayments may be a barrier to adherence. D Decreased use of the most cost-effective medications. Decreased Shipping/Mail Order Rates Question 45 2 Points Two desirable outcomes of tiered prescription benefits design are: A Brand drug use increases and generic drug use declines B The use of less expensive generic drugs increases, and members save money by paying lower copayments C Member costs increase and brand name drug use increases D Members pay higher copayments and pharmacies make higher gross profit margins Question 46 2 Points APR 1 atv 4 MacBook Air 20 DII F1 F2 F3 F4 F5 F6 F7 F 8 # % & 2 3 4 5 6 8View Assessment Homework Help - Q&A from Or X elearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 110 minutes remaining 50 OF 50 QUESTIONS REMAINING Question 38 2 Points Medicare Part A covers: A Prescription drugs B Long Term home health care C Ambulatory care services D npatient services/hospitalizations E Outpatient Physical Therapy Question 39 2 Points The one major goal of the 1996 Health Insurance Portability and Accountability Act (HIPAA) is A The mandate for all U.S. citizens to be guaranteed health care insurance coverage. B To ensure that immigrants will have the same health care in the U.S. as they have in their home country. C To enable senior citizens to keep their current physicians if they join a Medicare HMO. D The administrative simplification of electronic data transactions. APR 1 tv 4 MacBook Air 20 868 DII F1 F3 F4 F5 F6 F7 F8 # $ % & 4 5 6 8