Health Insurance Chap 7 & Ess. Chap 5 & Pharm. Chap 23
99 Questions
| Attempts: 86
Review week 3 mod 6
Questions and Answers
- 1.
A healthcare delivery system that controls utilization and cost of services while providing enrollees access to quality cost effective healthcare is
- A.
Commercial care
- B.
Managed care
- C.
Systemized care
- D.
Preventive care
Correct Answer
B. Managed care -
- 2.
Individuals who are members of a managed care plan are commonly referred to as
- A.
Patients
- B.
Employees
- C.
Enrollees
- D.
Subscribers
Correct Answer
C. Enrollees -
- 3.
A group of healthcare providers working under one umbrella to provide medical services at a discount to the individuals who participate in the plan is referred to as a/an
- A.
HMO
- B.
FFS
- C.
AMA
- D.
PPO
Correct Answer
D. PPO -
- 4.
A specific provider who oversees the total healthcare treatment of an individual enrolled in certain managed care plans is a
- A.
Participating provider
- B.
Primary care physician
- C.
Principal care provider
- D.
Treatment administrator
Correct Answer
B. Primary care physician -
- 5.
A relatively small out of pocket dollar amount that a member of a managed care plan typicallys pays up front is a
- A.
Copayment
- B.
Deductible
- C.
Premium
- D.
Compensation
Correct Answer
A. Copayment -
- 6.
A healthcare provider trained in a specific medical specialty is a
- A.
Specialist
- B.
Consultant
- C.
Counselor
- D.
Participating provider
Correct Answer
A. Specialist -
- 7.
A multispeciality practice in which healthcare services are provided within the building complex owned by the health maintenance organization (HMO) is referred to as a/an
- A.
IPA
- B.
Staff model
- C.
Network model
- D.
Direct contact model
Correct Answer
B. Staff model -
- 8.
A type of HMO whereby services are provided by outpatient networks composed of individual healthcare providers who supply all necessary patient care is a/an
- A.
IPA
- B.
Network model
- C.
Point of service
- D.
Direct contact model
Correct Answer
A. IPA -
- 9.
An advantage of managed care organizations (MCOs) is that their aim is to keep their enrollees healthy which is commonly referred to as
- A.
Health options
- B.
Preventive care
- C.
All inclusive care
- D.
Defensive treatment
Correct Answer
B. Preventive care -
- 10.
A private nonprofit organization that accredits healthcare plans based on evaluation of the quality of care given to plan members is the
- A.
AMA
- B.
NUCC
- C.
Joint commission
- D.
NCQA
Correct Answer
D. NCQA -
- 11.
An independent not for profit organization that sets standards for healthcare in the united states and accredits most major hospitals is the
- A.
AMA
- B.
NUCC
- C.
Joint commission
- D.
NCQA
Correct Answer
C. Joint commission -
- 12.
The formal term for a written complaint submitted by an individual covered by a special plan or policy is called a
- A.
Letter
- B.
Grievance
- C.
Complaint
- D.
Dispatch
Correct Answer
B. Grievance -
- 13.
A system designed to determine the medical necessity and appropriateness of a requested medical service or procedure is a/an
- A.
Appeal
- B.
Petition
- C.
Utilization review
- D.
Needs evaluation
Correct Answer
C. Utilization review -
- 14.
A procedure required by most healthcare plans before a provider carries out specific procedures or treatment is a/an
- A.
Appeal
- B.
Grievance
- C.
Equalization
- D.
Prequthorization
Correct Answer
D. Prequthorization -
- 15.
A procedure required by most healthcare plans before a provider carries out specific procedures or treatment is a/an
- A.
Appeal
- B.
Grievance
- C.
Equalization
- D.
Preauthorization
Correct Answer
D. Preauthorization -
- 16.
A request by a healthcare provider for his/her patient to be evaluated or treated by a specialist is a
- A.
Referral
- B.
Consultation
- C.
Confirmation
- D.
Preauthorization
Correct Answer
A. Referral -
- 17.
This federal act, passed in 1996 is intended to improve the efficiency of healthcare delivery, reduce administrative cost and protect patient privacy
- A.
HCFA
- B.
HIPPA
- C.
EMTLA
- D.
COBRA
Correct Answer
B. HIPPA -
- 18.
One primary function of a managed care organization (MCO) is to establish a list of covered benefits tied to managed care rules
- A.
True
- B.
False
Correct Answer
A. True -
- 19.
One of the more popular types of MCO in this country is the preferred provider organization (PPO)
- A.
True
- B.
False
Correct Answer
A. True -
- 20.
Under the federal HMO act an entity must have five characteristics to call itself an HMO
- A.
True
- B.
False
Correct Answer
B. False -
- 21.
Members of an HMO normally pay only a small fee (called a copayment) each time they visit their healthcare provider
- A.
True
- B.
False
Correct Answer
A. True -
- 22.
With a point of service type HMO patients are allowed to go outside the plan and use any provider they choose
- A.
True
- B.
False
Correct Answer
A. True -
- 23.
One advantage of an MCO is that it never has to be accredited
- A.
True
- B.
False
Correct Answer
B. False -
- 24.
Precertification is a process people must go through to become eligible to join an HMO
- A.
True
- B.
False
Correct Answer
B. False -
- 25.
A referral is exactly the same as a consultation
- A.
True
- B.
False
Correct Answer
B. False -
- 26.
The purpose of a consultation is to obtain an expert opinion only and care of the patient is not relinquished to the consulting provider
- A.
True
- B.
False
Correct Answer
A. True -
- 27.
Managed care has had little impact on healthcare in general in the united states
- A.
True
- B.
False
Correct Answer
B. False -
- 28.
The future of managed care is clear cut it is predicted that it will totally eliminate traditional healthcare in 10 years
- A.
True
- B.
False
Correct Answer
B. False -
- 29.
List the three main objectives of HIPAA
Correct Answer
to improve efficiency of health care delivery reduce administrative costs protect patient privacy - 30.
A specific provider who oversees the entire care and treatment of a patient in an HMO is called a
Correct Answer
PCP - 31.
With many MCOs the enrollee typically pays a small fee upfront when visiting his/her PCP called a ________________
Correct Answer
copayment - 32.
MCOs tend to focus on ____________ care, or keeping the patient well thus avoiding expensive treatment later on
Correct Answer
preventative - 33.
A predominant standard setting nonprofit organization that evaluates and accredits healthcare organizations in the united states is the ______________
Correct Answer
jcaho - 34.
A _____________________ is used in managed care plans to reduce unnecessary inpatient/outpatient services
Correct Answer
utilization review - 35.
__________________ pertains to medical necessity and appropriateness only and does not in all instances guarantee payment
Correct Answer
preauthorization - 36.
A process used by health insurance companies to control health care costs similar to prequthorization is
Correct Answer
precertification - 37.
A request by a healthcare provider for a patient under his/her care to be treated by another provider usually a specialist is a _______ (hint total care is often transferred)
Correct Answer
referral - 38.
When a patient is sent to another provider (often a specialist) with the intent of rendering an expert opinion only this is a ___________consultation (hint total care is not transferred)
Correct Answer
consultation - 39.
A "hybird" type of managed care (also called an open ended HMO) that allows patients to use either their HMO provider or go outside the plan and use a provider of their choices is a/ an _______________
Correct Answer
POS - 40.
The ________________ model HMO is similar to an IPA except the organization contracts directly with individual providers
Correct Answer
direct contact - 41.
The private not for profit organization that is dedicated to improving healthcare quality and is frequently referred to as the managed care "watch dog" is ___________
Correct Answer
NCQA - 42.
HMOs normally do not have _____________ or plan limits
Correct Answer
deductible - 43.
A defect in the _____ results in difficulty in visual detection of color and fine detail
- A.
Lens
- B.
Cones
- C.
Rods
- D.
Cones and rods
Correct Answer
B. Cones -
- 44.
The sensor receptive cells in the retina that function best in dim light and enable night vision are the
- A.
Iris
- B.
Pupil
- C.
Rods
- D.
Cones
Correct Answer
C. Rods -
- 45.
An inflammation of the thin transparent membrane covering the visible portion of the sclera and lining the inside of the eyelids results in
- A.
Conjunctivitis
- B.
Choroiditis
- C.
Cornea abrasion
- D.
Lens distortion
Correct Answer
A. Conjunctivitis -
- 46.
Hyperopia myopia and presbyopia are refractive errors that result when the
- A.
Pressure within the anterior chamber of the eye is elevated
- B.
Eye is unable to focus light effectively
- C.
Tympanic membrane ruptures
- D.
Lens of the eye becomes cloudy
Correct Answer
B. Eye is unable to focus light effectively -
- 47.
Which of the following statement(s) is (are) true about nystagmus
- A.
It is usually treated with warm compresses
- B.
It is also known as strabismus
- C.
It necessitates a complete neurologic evaluation when acquired
- D.
All of the above statements are true
Correct Answer
C. It necessitates a complete neurologic evaluation when acquired -
- 48.
Treatment of refractive errors of the eye might include
- A.
Laser surgery
- B.
Contact lenses
- C.
Eyeglasses
- D.
All of the above
Correct Answer
D. All of the above -
- 49.
Inflammatory infections of the hair follicles of the eyelid are called
- A.
Styes
- B.
Entropion
- C.
Keratitis
- D.
None of the above
Correct Answer
A. Styes -
- 50.
Conjunctivitis can be caused by
- A.
A deterioration of the lens
- B.
Infection, irritation, allergies or chemicals
- C.
Hemorrhage behind the retina
- D.
A drooping of the upper eyelid
Correct Answer
B. Infection, irritation, allergies or chemicals -
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