1. In most states, if a woman who's covered by a managed care plan believes that she's pregnant, she shouldfirst call her
A. primary care physician, to make an appointment so that she can be referred to an obstetrician." checked="checked" disabled="disabled">A.primary care physician, to make an appointment so that she can be referred to an obstetrician.
B. obstetrician, because she doesn't need preauthorization for care." disabled="disabled">B.obstetrician, because she doesn't need preauthorization for care.
C. managed care plan, to get preauthorization for care." disabled="disabled">C.managed care plan, to get preauthorization for care.
D. employer, to get preauthorization for care." disabled="disabled">D.employer, to get preauthorization for care.
2. Which accrediting organization would be most likely to post HMO and POS reports on the Internet?
A. URAC" checked="checked" disabled="disabled">A.URAC
B. NCQA" disabled="disabled">B.NCQA
C. JCAHO" disabled="disabled">C.JCAHO
D. HEDIS" disabled="disabled">D.HEDIS
6. A contributing factor to the rise in health care costs from the 1970s to the 1990s is
A. AIDS." disabled="disabled">A.AIDS.
B. SIDS." disabled="disabled">B.SIDS.
C. Medicaid." checked="checked" disabled="disabled">C.Medicaid.
D. Medicare." disabled="disabled">D.Medicare.
7. HMOs and PPOs are examples of
A. the Blues." disabled="disabled">A.the Blues.
B. Medicaid." disabled="disabled">B.Medicaid.
C. managed care plans." disabled="disabled">C.managed care plans.
D. point-of-service plans." checked="checked" disabled="disabled">D.point-of-service plans.
8. Continental Company employs 22 people-14 males and 8 females. According to the Model Act, this company would be considered a/an _______ employer.
A. discriminatory" checked="checked" disabled="disabled">A.discriminatory
B. well-balanced" disabled="disabled">B.well-balanced
C. growing" disabled="disabled">C.growing
D. small" disabled="disabled">D.small
9. Jim and Betty are married with one child, and both are employed by the same company. Jim, who was born on February 9, 1968, has been with the company for 10 years. Betty, who was born on May 12, 1965, has been with the company for 8 years. Who is the primary provider of health care coverage for the child?
A. Both Betty and Jim, because they have the same insurance" checked="checked" disabled="disabled">A.Both Betty and Jim, because they have the same insurance
B. Jim, because of his date of birth" disabled="disabled">B.Jim, because of his date of birth
C. Jim, because he's been with the company longer than Betty" disabled="disabled">C.Jim, because he's been with the company longer than Betty
D. Betty, because she's older than Jim" disabled="disabled">D.Betty, because she's older than Jim
10. A new mom delivered her healthy baby by cesarean section on Monday at 8 p.m. Her insurance company has told her doctor that if she goes home on Wednesday by 8 p.m., it will provide a visit by a nurse to the new mom's home. Is the insurance company able to offer this benefit? Why or why not?
A. No, the Newborns' and Mothers' Health Protection Act doesn't allow extra benefits for patients who don't use the 96 hours of allowed recovery time in the hospital unless those who stay receive it as well." disabled="disabled">A.No, the Newborns' and Mothers' Health Protection Act doesn't allow extra benefits for patients who don't use the 96 hours of allowed recovery time in the hospital unless those who stay receive it as well.
B. Yes, the new mom is allowed to have a nurse come to her home because she didn't use the full allowed amount of recovery time in the hospital." checked="checked" disabled="disabled">B.Yes, the new mom is allowed to have a nurse come to her home because she didn't use the full allowed amount of recovery time in the hospital.
C. No, the Newborns' and Mothers' Health Protection Act makes it mandatory that a new mom with a cesarean section remain in the hospital for a full 96 hours after delivery." disabled="disabled">C.No, the Newborns' and Mothers' Health Protection Act makes it mandatory that a new mom with a cesarean section remain in the hospital for a full 96 hours after delivery.
D. Yes, the insurance company may offer this as an option to staying in the hospital because hospital expenses are remarkably high." disabled="disabled">D.Yes, the insurance company may offer this as an option to staying in the hospital because hospital expenses are remarkably high.
11. Which one of the following types of review is conducted after a patient has already been treated for the purpose of determining if the treatment was appropriate?
A. Prospective" disabled="disabled">A.Prospective
B. Concurrent" disabled="disabled">B.Concurrent
C. Retrospective" disabled="disabled">C.Retrospective
D. Reactive" checked="checked" disabled="disabled">D.Reactive
12. According to a Supreme Court ruling in 1949, _______ now have a role in employee benefits.
A. all employees" disabled="disabled">A.all employees
B. insurance companies" checked="checked" disabled="disabled">B.insurance companies
C. senior management" disabled="disabled">C.senior management
D. unions" disabled="disabled">D.unions
14. In the 1990s, the major shift in health care was that most employees were now
A. covered by an indemnity plan." disabled="disabled">A.covered by an indemnity plan.
B. covered under a managed care plan." disabled="disabled">B.covered under a managed care plan.
C. covered under a traditional insurance plan." checked="checked" disabled="disabled">C.covered under a traditional insurance plan.
D. responsible for paying for their own insurance." disabled="disabled">D.responsible for paying for their own insurance.
15. A benefit plan that provides a less expensive choice for treatment is often a smart way to reduce costs. An example of this type of plan is
A. allowing the use of birthing centers." disabled="disabled">A.allowing the use of birthing centers.
B. allowing longer hospital stays." disabled="disabled">B.allowing longer hospital stays.
C. implementing maximum benefits." disabled="disabled">C.implementing maximum benefits.
D. requiring higher deductibles." checked="checked" disabled="disabled">D.requiring higher deductibles.
16. Because Dr. Roberts participates in an IPA, what type of patients can she see?
A. Any patient she wants to see" disabled="disabled">A.Any patient she wants to see
B. Only Medicare and Medicaid patients" disabled="disabled">B.Only Medicare and Medicaid patients
C. Only patients who have been assigned to her" disabled="disabled">C.Only patients who have been assigned to her
D. HMO patients" checked="checked" disabled="disabled">D.HMO patients
17. Suppose an employee's 18-year-old son has group medical insurance as a dependent of the employee. Which one of the following reasons would cause the son to lose his insurance benefits?
A. The son moves away to attend college." disabled="disabled">A.The son moves away to attend college.
B. The son graduates from high school." disabled="disabled">B.The son graduates from high school.
C. The employee becomes divorced." checked="checked" disabled="disabled">C.The employee becomes divorced.
D. The son joins the Navy." disabled="disabled">D.The son joins the Navy.
18. A benefit that does not try to cure a person's ailments, but rather attempts to make a patient comfortable in his or her last days or weeks before death, is called
A. home health care." disabled="disabled">A.home health care.
B. extended care." disabled="disabled">B.extended care.
C. hospice." disabled="disabled">C.hospice.
D. terminal care." checked="checked" disabled="disabled">D.terminal care.
19. An employer wishes to be assured that employees aren't seeking unneeded medical care. One approach to that objective is
A. MSAs." disabled="disabled">A.MSAs.
B. indemnity." disabled="disabled">B.indemnity.
C. self-management." checked="checked" disabled="disabled">C.self-management.
D. HIPC." disabled="disabled">D.HIPC.
20. Company X must make sure that it provides HMO coverage as an option in its benefit-selection process. What act would require Company X to do this?
A. Health Insurance Portability and Accountability Act" checked="checked" disabled="disabled">A.Health Insurance Portability and Accountability Act
B. Financial Services Modernization Act" disabled="disabled">B.Financial Services Modernization Act
C. Health Maintenance Organization Act" disabled="disabled">C.Health Maintenance Organization Act
D. Americans with Disabilities Act" disabled="disabled">D.Americans with Disabilities Act.