Question 1

Benchmarking is a quality improvement strategy used by some health plans. With regard to benchmarking, it is correct to say that

Options :

A :

cost-based benchmarking reveals why some areas of a health plan perform better or worse than comparable areas of other organizations

B :

diagnosis-related groups (DRGs) are a source of benchmarking data that describe individual procedures and cover both inpatient and outpatient care

C :

patient billing records provide a much more accurate account of procedure costs for benchmarking than do current procedural terminology (CPT) codes

D : the focus of benchmarking for health plan has shifted from identifying the lowest cost practices to identifying best practices

Answer: D

Question 2

A health plan’s coverage policies are linked to its purchaser contracts. The following statement(s) can correctly be made about the purchaser contract and coverage decisions: 1. In case of conflict between the purchaser contract and a health plan’s medical policy or benefits administration policy, the contract takes precedence 2. Purchaser contracts commonly exclude custodial care from their coverage of services and supplies 3. All of the criteria for coverage decisions must be included in the purchaser contract

Options :

A : All of the above

B : 1 and 2 only

C : 2 only

D : 3 only

Answer: B

Question 3

For this question, if answer choices (A) through (C) are all correct, select answer choice (D). Otherwise, select the one correct answer choice. The QAPI (Quality Assessment Performance Improvement Program) is a Centers for Medicaid and Medicare Services (CMS) initiative designed to strengthen health plans’ efforts to protect and improve the health and satisfaction of Medicare beneficiaries. QAPI quality assessment standards apply to

Options :

A : standard medical-surgical services

B : mental health and substance abuse services

C : services offered to Medicare enrollees as optional supplementary benefits

D : all of the above

Answer: D

Question 4

Increased demands for performance information have resulted in the development of various health plan report cards. With respect to most of the report cards currently available, it is correct to say

Options :

A : that they are focused primarily on health maintenance organization (HMO) plans

B : that they are based on data collected for the Health Plan Employer Data and Information Set (HEDIS) 3.0

C : that they are used to rank the performance of various health plans

D : all of the above

Answer: D

Question 5

Demetrius Farrell, age 82, is suffering from a terminal illness and has consulted his health plan

about the care options available to him. In order to avoid unwanted, futile interventions, Mr. Farrell

signed an advance directive that indicates the types of end-of-life medical treatment he wants to

receive. His family is to use this document as a guide should Mr. Farrell become incapacitated.

For this question, if answer choices (A) through (C) are all correct, select answer choice (D).

Otherwise, select the one correct answer choice.

Decisions regarding Mr. Farrell’s end-of-life care are legally the right and responsibility of

Options :

A : Mr. Farrell and his family

B : Mr. Farrell’s physician

C : Mr. Farrell’s health plan

D : All of the above

Answer: A

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