Managed care Training Test
This post-training quiz is designed to measure your understanding of Managed Care Basics. Please take a few minutes to answer the questions that follow.
Questions and Answers
- 1.
HMOs account for the majority of the Medicare Advantage enrollment in 2010.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
In 2010, the majority of the Medicare Advantage enrollment was accounted for by HMOs. This suggests that Health Maintenance Organizations (HMOs) were the preferred choice for individuals who opted for Medicare Advantage plans during that time. HMOs are known for providing comprehensive healthcare services through a network of healthcare providers, and it seems that their offerings resonated with a large number of Medicare beneficiaries in 2010.Rate this question:
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- 2.
Medicare Advantage plans only provide Medicare Part A services.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Medicare Advantage plans actually provide both Medicare Part A and Part B services. These plans are offered by private insurance companies approved by Medicare, and they provide all the benefits that Original Medicare offers, including hospital stays (Part A) and medical services (Part B). In addition, Medicare Advantage plans often include extra benefits such as prescription drug coverage, dental and vision care, and wellness programs. Therefore, the given statement is false.Rate this question:
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- 3.
RUG reimbursements are the most common reiumbursement mechanism utilized by managed care plans.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The statement is false because RUG reimbursements are not the most common reimbursement mechanism utilized by managed care plans. There are various other reimbursement mechanisms used by managed care plans, such as fee-for-service, capitation, and bundled payments.Rate this question:
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- 4.
Managed care per diem reimbursements are the second highest payer next to Medicare.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Managed care per diem reimbursements are the second highest payer next to Medicare because managed care plans, such as HMOs and PPOs, negotiate rates with healthcare providers and pay a fixed amount for each day of care provided to a patient. These reimbursements are often higher than those from other insurance plans, such as Medicaid or private insurance, making managed care per diem reimbursements the second highest payer after Medicare, which is a government-funded healthcare program for individuals aged 65 and older.Rate this question:
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- 5.
A quarter of all Medicare beneficiaries are enrolled in a Medicare Advantage plan.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
The statement states that a quarter of all Medicare beneficiaries are enrolled in a Medicare Advantage plan. This means that out of all the people who receive Medicare benefits, 25% of them have chosen to enroll in a Medicare Advantage plan.Rate this question:
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- 6.
Medicare Advantage Plans must offer at a minimum the same benefits as Medicare.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Medicare Advantage Plans are required to offer the same benefits as Medicare, at a minimum. This means that they must provide the basic benefits covered by Medicare, such as hospital insurance (Part A) and medical insurance (Part B). However, Medicare Advantage Plans often offer additional benefits, such as prescription drug coverage (Part D) or dental and vision services. Therefore, the statement "Medicare Advantage Plans must offer at a minimum the same benefits as Medicare" is true.Rate this question:
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- 7.
A Special Needs Plan (SNP) is not a Medicare Advantage plan.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
A Special Needs Plan (SNP) is actually a type of Medicare Advantage plan. SNPs are designed specifically for individuals with certain special needs, such as chronic illnesses or disabilities. These plans provide tailored benefits and services to meet the unique needs of these individuals. Therefore, the statement that SNP is not a Medicare Advantage plan is false.Rate this question:
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- 8.
Medicare Advantage plans are not allowed to offer any additional benefits than Medicare.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Medicare Advantage plans are allowed to offer additional benefits beyond what is covered by traditional Medicare. These additional benefits can include prescription drug coverage, dental, vision, and hearing services, fitness programs, and transportation services. Therefore, the given statement is incorrect.Rate this question:
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- 9.
Individuals must have Medicare Part A and Part B to be eligible to join a Medicare Advantage plan.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
To be eligible to join a Medicare Advantage plan, individuals must have both Medicare Part A and Part B. Medicare Part A covers hospital insurance, while Part B covers medical insurance. Therefore, individuals need to have both parts of Medicare in order to qualify for a Medicare Advantage plan, which is provided by private insurance companies approved by Medicare.Rate this question:
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- 10.
A facility must pass a managed care organization’s credentialing process before they can be considered a contracted provider.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
In order for a facility to be considered a contracted provider by a managed care organization, it is necessary for them to pass the organization's credentialing process. This process ensures that the facility meets certain standards and qualifications set by the organization, such as appropriate licensure, accreditation, and quality of care. By passing the credentialing process, the facility demonstrates its ability to provide services in accordance with the managed care organization's requirements, making the statement true.Rate this question:
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- 11.
Managed Care contract summaries can be found on the company portal.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Managed Care contract summaries can be found on the company portal. This statement is true because managed care contract summaries are typically made available to employees or members of a company through their online portal. The company portal is a centralized platform where important information, documents, and resources are stored and accessible to authorized individuals. Therefore, it is likely that managed care contract summaries would be included in the company portal for easy access and reference.Rate this question:
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- 12.
Accessibility of a provider’s services is important to a managed care organization.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Accessibility of a provider's services is important to a managed care organization because it ensures that members have timely and convenient access to the healthcare services they need. This includes having a sufficient number of providers within the network, offering extended hours of operation, and having multiple locations available. By prioritizing accessibility, managed care organizations can improve member satisfaction, enhance care coordination, and ultimately achieve better health outcomes for their members.Rate this question:
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- 13.
Health plans monitor its members’ length of stay in a SNF.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Health plans monitor the length of stay in a skilled nursing facility (SNF) because it helps them assess the cost and effectiveness of care provided to their members. By tracking how long members stay in a SNF, health plans can evaluate if the facility is providing appropriate and necessary care. This information also allows them to manage and allocate resources effectively, ensuring that members receive the right level of care for the appropriate duration. Monitoring length of stay helps health plans optimize the quality and cost-efficiency of care provided to their members in SNFs.Rate this question:
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- 14.
Plan provider directories can be downloaded from the Internet.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Plan provider directories can indeed be downloaded from the internet. These directories provide information about the healthcare providers that are covered by a particular insurance plan. By downloading these directories, individuals can easily access information about the doctors, hospitals, and other healthcare facilities that are in-network for their insurance plan. This allows them to make informed decisions about their healthcare choices and find providers that are covered by their insurance.Rate this question:
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- 15.
Managed Care is a broad term that refers to a system that manages the quality of health care, access to care and the cost of that care.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Managed Care is indeed a broad term that encompasses various systems and approaches aimed at managing the quality, accessibility, and cost of healthcare. These systems often involve the coordination and integration of healthcare services, the use of networks of healthcare providers, and the implementation of strategies to control costs and improve patient outcomes. Therefore, the statement that Managed Care refers to a system that manages the quality of health care, access to care, and the cost of that care is accurate.Rate this question:
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- 16.
Medicare contracts with private insurers to deliver Medicare benefits through Medicare Advantage products.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Medicare does indeed contract with private insurers to provide Medicare benefits through Medicare Advantage products. This means that beneficiaries can choose to receive their Medicare coverage through private insurance companies that have been approved by Medicare. These private insurers offer different Medicare Advantage plans that provide the same benefits as Original Medicare, but may also include additional benefits such as prescription drug coverage or dental and vision services. This arrangement allows beneficiaries to have more options for their Medicare coverage and potentially receive additional benefits not covered by Original Medicare.Rate this question:
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- 17.
Medicare Advantage plans typically offer additional benefits such as gym memberships, vision and hearing benefits than those offered by Medicare.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Medicare Advantage plans are private health insurance plans that provide coverage in addition to what is offered by original Medicare. These plans often include additional benefits such as gym memberships, vision, and hearing benefits. Therefore, the statement that Medicare Advantage plans typically offer these additional benefits is true.Rate this question:
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- 18.
Medicare Advantage plans are sometimes referred to as “Part C” plans.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Medicare Advantage plans are indeed sometimes referred to as "Part C" plans. This is because they are an alternative to Original Medicare (Part A and Part B) and are offered by private insurance companies approved by Medicare. These plans provide all the benefits of Original Medicare and often include additional coverage such as prescription drugs, dental, vision, and hearing services. The "Part C" designation helps distinguish these plans from the other parts of Medicare and highlights their comprehensive nature.Rate this question:
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- 19.
A Medicare beneficiary can join or switch a Medicare Advantage plan at any time during the year.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
A Medicare beneficiary cannot join or switch a Medicare Advantage plan at any time during the year. Instead, they can only make changes to their Medicare Advantage plan during specific enrollment periods, such as the Annual Enrollment Period (AEP) or the Special Enrollment Period (SEP). Outside of these enrollment periods, beneficiaries generally cannot make changes to their Medicare Advantage plan unless they qualify for a specific exception or special circumstance. Therefore, the statement that a Medicare beneficiary can join or switch a Medicare Advantage plan at any time during the year is false.Rate this question:
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- 20.
Medicare Advantage plans are concerned with the clinical outcomes of its contracted providers.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Medicare Advantage plans focus on the clinical outcomes of the providers they contract with. This means that they prioritize the quality and effectiveness of the medical care provided by these providers. By emphasizing clinical outcomes, Medicare Advantage plans aim to ensure that beneficiaries receive high-quality healthcare that leads to positive health outcomes. This focus on outcomes helps to improve the overall quality of care delivered to Medicare Advantage beneficiaries.Rate this question:
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- 21.
Please provide your name and mailing address so we can mail your certificate.
Quiz Review Timeline +
Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.
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Current Version
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Mar 21, 2023Quiz Edited by
ProProfs Editorial Team -
Apr 21, 2011Quiz Created by
Aglassman
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