Which of the following clauses states that the provider agrees not to sue or assert any claims against the enrollee for services covered under the contract?
Question 1. [http://www.bezern.com/]1. [http://www.bezern.com/] (TCO B) The original impetus of HMO development came from which of the following? (Points : 5) Providers seeking patient revenues Consumers seeking access to healthcare Employers All of the above None of the above Question 2. [http://www.bezern.com/]2. [http://www.bezern.com/] (TCO A) Key common characteristics of PPOs include _____. [http://www.bezern.com/] (Points : 5) selected provider panels negotiated payment rates consumer choice utilization management All of the above A, B, and D only Question 3. [http://www.bezern.com/]3. [http://www.bezern.com/] (TCO B) Basic elements of credentialing include _____. [http://www.bezern.com/] (Points : 5) hospital privileges malpractice history medical license continuing medical education (CME) All of the above A, B, and C only Question 4. [http://www.bezern.com/]4. [http://www.bezern.com/] (TCO D) A common financial risk arrangement used as a performance-based incentive is _____. [http://www.bezern.com/] (Points : 5) carve-outs withholds per diem FFS Question 5. [http://www.bezern.com/]5. [http://www.bezern.com/] (TCO B) Which of the following forms of hospital reimbursement contain no elements of risk sharing by the hospital? (Points : 5) Capitation DRGs Per diem Sliding scale FFS Both C and D Question 6. [http://www.bezern.com/]6. [http://www.bezern.com/] (TCO C) Common sources of information to trigger DM include _____. [http://www.bezern.com/] (Points : 5) claims laboratory tests referrals from inpatient care coordinators pharmacy data electronic medical records All of the above A through D only Question 7. [http://www.bezern.com/]7. [http://www.bezern.com/] (TCO C) One potential negative consequence of drug formularies with high copayments is _____. [http://www.bezern.com/] (Points : 5) increased use of generic drugs increased use of brand drugs copayments may be a barrier to adherence. [http://www.bezern.com/] decreased use of the most cost-effective medications Question 8. [http://www.bezern.com/]8. [http://www.bezern.com/] (TCO C) Which of the following are components of a strong MCO prevention program? (Points : 5) Member benefits Services for members, such as health risk assessments Contracts with providers Public policies A and C only A, B, C, and D Question 9. [http://www.bezern.com/]9. [http://www.bezern.com/] (TCO D) This federal law has established specific, enforceable regulations regarding the standardization of electronic transactions and code sets for procedures and diagnoses. [http://www.bezern.com/] (Points : 5) OCR HEDIS HIPAA EMTALA Question 10. [http://www.bezern.com/]10. [http://www.bezern.com/] (TCO D) Employees who are engaged in their healthcare will do the following except what? (Points : 5) Have better compliance with health intervention programs Have lower healthcare costs Have higher productivity Have more direct reports Question 11. [http://www.bezern.com/]11. [http://www.bezern.com/] (TCO D) Which of the following does HIPAA regulate? (Points : 5) Electronic communications between payors and providers Portability and access standards Guaranteed renewability of group coverage All of the above Question 12. [http://www.bezern.com/]12. [http://www.bezern.com/] (TCO D) Which of the following clauses states that the provider agrees not to sue or assert any claims against the enrollee for services covered under the contract? (Points : 5) Flow down clause No-balance-billing clause Force majeure clause Hold-harmless clause