HSM 546 Final Exam

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HSM 546 Final Exam 
Which federal law has established specific, enforceable regulations to help ensure the privacy….

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HSM 546 Final Exam

HSM 546 Final Exam

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(COs A, B, and D) Capitation is defined as _____.

Prepayment for services on a fixed, per member, per month basis

Fee-for-service, including withhold provisions

Performance based compensation system

Stop-loss reinsurance provisions

(COs A, B, and D) Which federal law has established specific, enforceable regulations to help ensure the privacy and confidentiality of individual health information?

OCR

HEDIS
HIPPA
EMTALA

(COs A, B, D and G) The fee for service (FFS) payment method may encourage _____.

Unbundling

Upcoding

Churning

All of the above

(COs A, B, C, D, E, F, G, & H) What is disease management?

Disease management refers to a system of coordinated health care communications and interventions for populations with conditions where…

COs A, B, C, D, E, F, G, & H) Explain what integrated delivery systems are, and provide some examples.

The concept of integrated delivery system involves placing all required levels of care within a single integrated…

(TCOs A, B, and D) Managed health care is best described as _____.

An insurance company that provides health services

A broad and constantly changing array of health plans that attempt to manage both cost and quality of care

An inexpensive form of payment for health services

(TCOs A, B, and D) Which type of case is least likely to benefit from case management?

Cancer

AIDS

Normal vaginal delivery

All of the above

(TCOs A, B, and D) Which of the following organizations has developed accreditation programs for managed care organizations?

NCQA

URAC

AAAHC

A and B

All of the above

(TCOs A, B, and D) The integral components of managed care are _____.

Wellness and prevention

Primary-care orientation

Utilization management

Wellness, prevention, and utilization management

All of the above

(TCOs A, B, and D) The purpose of ERISA is to _____.

Ensure that all individuals receive emergency medical care, regardless of their ability to pay for services

Ensure the continuation of coverage for individuals who may lose health insurance due to termination of their employment

To protect workers in employee insurance plans and their beneficiaries by the requirement of disclosure and reporting financial and other information to workers and their beneficiaries

All of the above

(TCOs A, B, and D) Fees for services are generally determined by using _____.

Quality indicator measures

HMO insurance fee schedules

HMO insurance fee schedules

The type of services provided

(TCO A) Describe the key steps in developing a modern quality management program.

https://www.hiqualitytutorials.com/product/describe-key-steps-in-developing-modern/

The first step to developing a modern quality management program is to identify the scope of the problem and estimate the benefits of…

(TCO H) Explain what a gag clause is, and why it is important in managed care plans.

https://www.hiqualitytutorials.com/product/explain-what-a-gag-clause-is/

The gag clause is a legislation clause that prohibits physicians from frankly and openly discussing all treatment options – whether covered or…

(TCO C) Discuss the purpose of the Patient Protection and Affordable Care Act.

https://www.hiqualitytutorials.com/product/discuss-purpose-of-patient-protection/

The Patient Protection and Affordable Care Act, which was signed into law on March 2010, was intended to extend coverage to the millions of Americans who are…

(TCO E) Describe the role of state government in the regulation of managed care.

https://www.hiqualitytutorials.com/product/describe-role-of-state-government/

While the federal government regulates managed care and health plans sponsored by private-sector employers, the state governments regulate the….

(TCO F) Discuss the role of the primary care physician in utilization management.

https://www.hiqualitytutorials.com/product/discuss-role-of-primary-care-physician/

The primary care physicians play a big role in utilization management because they can greatly influence how much care a patient receives. Since a primary care…

(COs A, B, C, D, E, F, G, & H) What is disease management?

https://www.hiqualitytutorials.com/product/hsm546-what-is-disease-management/

Disease management refers to a system of coordinated health care communications and interventions for populations with conditions where…

(COs A, B, C, D, E, F, G, & H) Explain what integrated delivery systems are, and provide some examples.

https://www.hiqualitytutorials.com/product/explain-what-integrated-delivery-systems-are/

The concept of integrated delivery system involves placing all required levels of care within a single integrated…

(TCO H) Discuss the three broad types of structure for managed care plans.

https://www.hiqualitytutorials.com/product/discuss-three-broad-types-of-structure/

The three broad types of structure for managed care plans are health maintenance organizations (HMOs), Point of Service (PS), and…

(TCO C) Explain the relationship between provider networks, managed care plans, and plan members. What is the importance of this relationship?

https://www.hiqualitytutorials.com/product/explain-relationship-between-provider-networks/

Managed care plans are a type of health insurance, which enters into contract with medical facilities and healthcare providers…

(COs D and E) Explain the HMO Act of 1973 and how the act changed the government’s role in managed care.

https://www.hiqualitytutorials.com/product/explain-the-hmo-act-of-1973/

The HMO Act of 1973 is a US federal law enacted under President Richard Nixon’s administration. It intends to encourage…

(COs G and H) Discuss the categories that fall under the state requirements for the health insurance market, and the laws that govern health insurance markets. What is it and why is it important?

https://www.hiqualitytutorials.com/product/discuss-categories-that-fall-under-state-requirements/

The categories that fall under the state requirements for the health insurance market are HMOs, PPOs, and POS plans. HMOs…

HSM 546 Final Exam

Keller