Healthcare Multiple Choice Questions
1)The managed care phenomenon was welcomed mostly by
a.employers
b.workers
c.private insurance
d.the government
2) With the growth of managed care, the balance of power in the medical marketplace swung toward
a.providers
b.the supply side
c.the demand side
d.more regulation
3) A managed care organization functions like
a.a provider
b.an insurer
c.a regulator
d.a financier
4) What is the purpose of risk sharing with providers?
a.It makes providers immune to costs
b.It makes providers cost conscious
c.It rewards providers for quality
d.It keeps insurance premiums low
5)Capitation is best described as
a.monthly lump sum payment regardless of utilization
b.monthly lump sum payment regardless of cost
c.per member per month payment
d.payments capped to a maximum cost for delivering services
6)Under capitation, risk is shifted
a.from the insured to the employer
b.from the provider to the MCO
c.from the employer to the MCO
d.from the MCO to the provider
7) Under which payment method is a fee schedule used?
a.prospective payment
b.capitation
c.discounted fees
d.fee for service
8)The HMO Act of 1973 required
a.health care providers to contract with HMOs
b.managed care organizations to offer HMO alternatives
c.insurers to switch to managed care
d.employers to offer an HMO alternative to conventional health insurance
9)In the term, managed care, 'manage' refers to
a.management of utilization
b.management of premiums
c.management of risk
d.management of the supply of services
10)Under the fee-for-service system, providers had the incentive to
a.deliver more services than what would be medically necessary because a greater volume would increase their incomes
b.use less technology because they could increase their incomes by not using costly procedures
c.indiscriminate cost increases because they could get paid whatever they would charge
d.increase the level of quality in order to attract more patients
11)In the beginning, why did HMOs only had limited appeal?
a.HMOs faced resistance from employers
b.The shadow pricing practices used by HMOs were declared illegal
c.The HMOs had only limited ability to control costs.
d.The insured wanted to maintain the choice of providers
12)Closed-panel plan.
a.No new physicians can be added to the plan
b.New enrollees are not accepted by the plan
c.The enrollee cannot switch from one plan to another
d.The enrollee is restricted to the providers on the panel
13)Gatekeeping heavily depends on the services of a
a.primary care physician
b.case manager
c.disease consultant
d.nurse practitioner
14)Gatekeeping emphasizes
a.denial of specialized services
b.closed-panel utilization
c.preventive and primary care
d.secondary care
15)Under _____ a primary care physician becomes the portal of entry to the health care delivery system.
a.case management
b.utilization review
c.gatekeeping
d.closed-panel utilization
16)Cost-effective management of care for patients who have complex medical conditions.
a.Case management
b.Gatekeeping
c.Utilization management
d.Managed care
17)A primary care physician decides whether or not to refer a patient to a specialist.
a.Preauthorization
b.Prospective utilization review
c.Disease management
d.Closed-panel utilization
18)Precertification is the responsibility of
a.the gatekeeper
b.the case manager
c.the health plan
d.the employer
19)Under prospective utilization review, if a case is determined to be potentially complex and costly, it is referred to
a.case management
b.concurrent utilization review
c.appropriate specialists
d.discharge planners
20)Concurrent UR in a hospital will be primarily concerned with the
a.disease process
b.length of stay
c.preauthorizations
d.quality management
21)Closely associated with concurrent UR is the function of
a.preauthorization
b.rehabilitation
c.practice profiling
d.discharge planning
22)Review of patterns of practice is undertaken as part of
a.concurrent utilization review
b.retrospective utilization review
c.prospective utilization review
d.case management
23)Data collection and statistical analysis are often part of
a.concurrent utilization review
b.retrospective utilization review
c.prospective utilization review
d.case management
24)Monitoring of provider-specific practice patterns.
a.concurrent utilization review
b.retrospective utilization review
c.case management
d.practice profiling
25)When an MCO adopts capitation as the primary method of payment, which service is likely to be carved out?
a.Specialty care
b.Gatekeeping
c.Mental health
d.Primary care
26)Physicians are employees of the HMO.
a.Preferred providers
b.IPA model
c.Staff model
d.Independent practice association
27)Which HMO model is likely to provide the greatest control over the practice patterns of physicians?
a.Staff model
b.Group model
c.Network model
d.IPA model
28)In which HMO model is the choice of physicians likely to be most restricted?
a.Staff model
b.Group model
c.Network model
d.IPA model
29)Which HMO model is likely to require heavy capital outlays to expand into new markets?
a.Staff model
b.Group model
c.Network model
d.IPA model
30)Who employs the physicians in the group practice model?
a.The HMO
b.The group practice
c.The IPA
d.The PPO
31)A network model HMO
a.employs its own network of physicians
b.exclusively uses the services of an independent practice association
c.owns a network of physicians and hospitals
d.contracts with more than one group practices
32)Which model of HMO was specifically included in the HMO Act of 1973?
a.Staff model
b.Group model
c.Network model
d.IPA model
33)Under which model is an HMO relieved of the burden to establish contracts with providers and monitor utilization?
a.Staff model
b.Group model
c.Network model
d.IPA model
34)Who is likely to bear the most financial risk under the IPA model?
a.The IPA
b.The providers
c.The HMO
d.The employers
35)Among HMOs, which model is predominant in the marketplace?
a.Staff model
b.Group model
c.Network model
d.IPA model
36)PPOs were created by ____ in response to HMOs' growing market share.
a.physicians
b.insurance companies
c.hospitals
d.independent contractors
37)PPOs differentiated themselves by offering _____ options to enrollees.
a.point of service
b.no out-of-pocket payment
c.open-panel
d.discount
38)A hybrid between an HMO and a PPO.
a.Point-of-service plans
b.Mixed model HMO
c.IPA
d.Exclusive provider plans
39)Which type of MCO has achieved the greatest success in member enrollment?
a.HMOs
b.PPOs
c.POS plans
d.Exclusive provider plans
40)How are employers coping with the rising cost of health insurance premiums?
a.They are dropping health benefits in large numbers
b.They are enrolling a greater number of their employees into HMOs
c.They are shifting costs to their employees
d.They are switching to high-deductible health plans in large numbers
41)Which legislation was mainly responsible for giving states the authority to enroll a large number of Medicaid recipients into managed care?
a.Tax Equity and Fiscal Responsibility Act of 1982
b.Balanced Budget Act of 1997
c.HMO Act of 1973
d.Deficit Reduction Act of 2005
42)Which legislation was mainly responsible for the decline of Medicare enrollments in managed care after a rise in enrollments?
a.Tax Equity and Fiscal Responsibility Act of 1982
b.Balanced Budget Act of 1997
c.Medicare Prescription Drug, Improvement, and Modernization Act of 2003
d.Deficit Reduction Act of 2005
43)The Newborns' and Mothers' Health Protection Act of 1996 prohibits a health plan to offer less than _____ of inpatient stay following a normal vaginal delivery.
a.24 hours
b.48 hours
c.3 days
d.4 days
44)The Newborns' and Mothers' Health Protection Act of 1996 prohibits a health plan to offer less than _____ hours of inpatient stay following a Caesarean section.
a.48
b.72
c.96
d.120
45)Which of the following is not an example of consolidation?
a.Building of new facilities
b.Acquiring an existing facility
c.Merging with an existing organization
d.Alliances among existing organizations
46)Which of these organizations was specifically created to bring management expertise to physician group practices?
a.Virtual organizations
b.Physician-hospital organizations
c.Provider-sponsored organizations
d.Management services organizations
47)An organization ceases to exist as a separate entity and is absorbed into the purchasing corporation.
a.Acquisition
b.Merger
c.Joint venture
d.Alliance
48)Two organizations cease to exist, and a new corporation is formed.
a.Acquisition
b.Merger
c.Joint venture
d.Alliance
49)A new corporation created by two partnering organizations remains independent.
a.Acquisition
b.Merger
c.Joint venture
d.Alliance
50)A type of integration that does not involve any joint ownership of assets.
a.Acquisition
b.Merger
c.Joint venture
d.Alliance
51)What type of integration is represented by a chain of nursing homes?
a.Vertical integration
b.Network
c.Horizontal integration
d.Diversification
52)Regional health systems are often
a.horizontally integrated
b.vertically integrated
c.formed into virtual organizations
d.formed into alliances
53)Antitrust legislation is intended to provide checks against
a.anticompetitive behavior
b.fraud and abuse
c.self-referral of patients
d.payments for patient referrals