Question 1

Medicaid beneficiaries pose a challenge for health plans attempting to establish Medicaid provider networks. Compared to membership in commercial health plans, Medicaid enrollees typically

Options :

A : Require access to greater numbers of obstetricians and pediatricians

B : Have stronger relationships with primary care providers

C : Are less reliant on emergency rooms as a source of first-line care

D : Need fewer support and ancillary services

Answer: A

Question 2

A population’s demographic factors—such as income levels, age, gender, race, and ethnicity—can influence the design of provider networks serving that population. With respect to these demographic factors, it is correct to say that

Options :

A :

higher-income populations have a higher incidence of chronic illnesses than do lowerincome populations

B : compared to other groups, young men are more likely to be attached to particular providers

C :

a population with a high proportion of women typically requires more providers than does a population that is predominantly male

D :

Health plans should not recognize, in either the design of networks or the evaluation of provider performance, racial and ethnic differences in the member population

Answer: C

Question 3

In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA), which increased the continuity and portability of health insurance coverage. One statement that can correctly be made about HIPAA is that it

Options :

A : Applies to group health insurance plans only

B :

Limits the length of a health plan’s pre-existing condition exclusion period for a previously covered individual to a maximum of six months after enrollment.

C :

Guarantees access to healthcare coverage for small businesses and previously covered individuals who meet specified eligibility requirements.

D :

Guarantees renewability of group and individual health coverage, provided the insureds are still in good health

Answer: C

Question 4

With respect to hiring practices, one step that a health plan most likely can take to avoid violating the terms of the Americans with Disabilities Act (ADA) is to

Options :

A : Require a medical examination prior to accepting an application for employment

B : Include in the employment application questions pertaining to health status

C : Make a conditional offer of employment, and then require the candidate to have an examination prior to granting specific staff privileges

D : Require applicants to answer questions pertaining to the use of drugs and alcohol

Answer: C

Question 5

One reimbursement method that health plans can use for hospitals is the ambulatory payment classifications (APCs) method. APCs bear a resemblance to the diagnosis-related groups (DRGs) method of reimbursement. However, when comparing APCs and DRGs, one of the primary differences between the two methods is that only the APC method

Options :

A : is typically used for outpatient care

B : assigns a single code for treatment

C : applies to treatment received during an entire hospital stay

D : is considered to be a retrospective payment system

Answer: A

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