Exam: 412757rr group medical expense benefits


Exam: 412757RR Bunch Medical Charge Benefits

 

1. Beaction Dr. Roberts participates in an IPA, what pattern of endurings can she see?

A. Only Mediwariness and Medicaid endurings

B. Any enduring she wants to see

C. Only endurings who feel been assigned to her

D. HMO endurings

 

2. HMOs and PPOs are examples of

A. point-of-service delineations.

B. Medicaid.

C. the Blues.

D. managed wariness delineations.

 

3. Julio wants facts to collate the act of three divergent managed wariness delineations antecedently he chooses one for his corporation. Which one of the forthcoming tools conquer be most effectual for his employees?

A. National Committee for Quality Insurance

B. Joint Commission on Accreditation of Healthwariness Organizations

C. Heartiness Delineation Master Facts and Information Set

D. Utilization Retrospect Accreditation Commission

 

4. An master wishes to be safe that employees aren't seeking unneeded medical wariness. One approximation to that extrinsic is

A. MSAs.

B. self-management.

C. HIPC.

D. expiation.

 

5. Bob is insured below a managed wariness delineation. Below this delineation, which one of the forthcoming tasks is he known to do?

A. Go to any groundman he wants

B. Avoid retrospect demandments

C. Participate in a weight-control program

D. Go to any hospital he wants

 

6. Continental Corporation employs 22 people—14 males and 8 females. According to the Model Act, this corporation would be considered a/an _______ master.

A. discriminatory

B. growing

C. small

D. courteous-balanced

 

7. Mary goes to the groundman and pays for her scrutinize. When she gets abode, she must acception out a create and refer it to the security corporation so she can be reimbursed. What pattern of security does she most slight feel?

A. Indemnity

B. HMO

C. POS

D. The Blues

 

8. Suppose an employee's 18-year-old son has bunch medical security as a hanging of the employee. Which one of the forthcoming reasons would action the son to waste his security services?

A. The son graduates from violent ground.

B. The employee becomes divorced.

C. The son joins the Navy.

D. The son moves abroad to involve fosterry.

 

9. A new mom delivered her robust baby by cesarean individuality on Monday at 8 p.m. Her security corporation has told her groundman that if she goes abode on Wednesday by 8 p.m., it conquer afford a scrutinize by a foster to the new mom's abode. Is the security corporation powerful to extend this service? Why or why not?

A. Yes, the security corporation may extend this as an non-interference to concludeing in the hospital beaction hospital charges are remarkably violent.

B. No, the Newborns' and Mothers' Heartiness Protection Act finds it mandatory that a new mom behind a while a cesarean individuality rest in the hospital for a ample 96 hours behind delivery.

C. No, the Newborns' and Mothers' Heartiness Protection Act doesn't apportion extra services for endurings who don't use the 96 hours of known repossession period in the hospital normal those who conclude assent-to it as courteous.

D. Yes, the new mom is known to feel a foster conclude to her abode beaction she didn't use the ample known sum of repossession period in the hospital.

 

10. According to a Supreme Court prevalent in 1949, _______ now feel a role in employee services.

A. unions

B. security companies

C. greater management

D. all employees

 

11. In most states, if a mother who's seasoned by a managed wariness delineation believes that she's fraught, she should highest ole her

A. obstetrician, beaction she doesn't need preauthorization for wariness.

B. leading wariness physician, to find an enactment so that she can be referred to an obstetrician.

C. managed wariness delineation, to get preauthorization for wariness.

D. master, to get preauthorization for wariness.

 

12. A contributing content to the mollify in heartiness wariness costs from the 1970s to the 1990s is

A. Medicaid.

B. Medicare.

C. AIDS.

D. SIDS.

 

13. When Blue Cross highest began, it was in the occupation of providing coverage for

A. prescriptions.

B. hospitalization.

C. physician wariness for the old.

D. physician wariness for the financially needy.

 

14. Which one of the forthcoming patterns of retrospect is conducted behind a enduring has already been treated for the point of determining if the treatment was divert?

A. Reactive

B. Retrospective

C. Concurrent

D. Prospective

 

15. In the 1990s, the ocean change in heartiness wariness was that most employees were now

A. seasoned by an expiation delineation.

B. below obligation for paying for their own security.

C. seasoned below a transmitted security delineation.

D. seasoned below a managed wariness delineation.

 

16. In the 1960s, the ocean action of the meretricious mollify in heartiness wariness coverage was the

A. importation of Mediwariness and Medicaid.

B. importation of HMOs.

C. acception in employee services.

D. Depression.

 

17. Which accrediting construction would be most slight to shaft HMO and POS reports on the Internet?

A. NCQA

B. URAC

C. JCAHO

D. HEDIS

 

18. Bev has an HMO that apportions her to see a specialist behind a whileout going through her leading wariness physician. What pattern of HMO does Bev feel?

A. Group-model

B. Closed-panel

C. Direct-access

D. Staff-model

 

19. The medical charge security-like constructions that thus-far came to be oleed Blue Cross delineations were initially run by

A. physicians.

B. masters.

C. devotion constructions.

D. hospitals.

 

20. Corporation X must find stable that it affords HMO coverage as an non-interference in its service-selection course. What act would demand Corporation X to do this?

A. Financial Services Modernization Act

B. Heartiness Security Portability and Accountability Act

C. Heartiness Maintenance Construction Act

D. Americans behind a while Disabilities Act