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Questions # 1:

Managed behavioral health organizations (MBHOs) use several strategies to manage the delivery of behavioral healthcare services. The following statements are about these strategies.

Select the answer choice that contains the correct statement.

Options:
A.

MBHOs generally provide benefits for mental health services but not for chemical dependency services.

B.

The level of care needed to treat behavioral disorders is the same for all patients and all disorders.

C.

By using outpatient treatment more extensively, MBHOs have decreased the use of costly inpatient therapies.

D.

PCP gatekeeper systems for behavioral healthcare generally result in more accurate diagnoses, more effective treatment, and more efficient use of resources than do centralized referral systems.

Questions # 2:

One characteristic of disease management programs is that they typically

Options:
A.

focus on individual episodes of medical care rather than on the comprehensive care of the patient over time

B.

are used to coordinate the care of members with any type of disease, either chronic or nonchronic

C.

focus on managing populations of patients who have a specific chronic illness or medical condition, but do not focus on patient populations who are at risk of developing such an illness or condition

D.

use clinical practice processes to standardize the implementation of best practices among providers

Questions # 3:

The Blaine Healthcare Corporation seeks to manage its quality by first identifying the best practices and best outcomes for a given procedure. Blaine can then determine areas in which it can emulate the best practices in order to equal or surpass the best

Options:
A.

provider profiling

B.

benchmarking

C.

peer review

D.

quality assessment

Questions # 4:

One true statement regarding ethics and laws is that the values of a community are reflected in

Options:
A.

both ethics and laws, and both ethics and laws are enforceable in the court system

B.

both ethics and laws, but only laws are enforceable in the court system

C.

ethics only, but only laws are enforceable in the court system

D.

laws only, but both ethics and laws are enforceable in the court system

Questions # 5:

The following paragraph contains an incomplete statement. Select the answer choice containing the term that correctly completes the statement. Advances in computer technology have revolutionized the processing of medical and drug claims. Claims processing i

Options:
A.

Lower

B.

Higher

C.

Same

D.

No change

Questions # 6:

Janet Riva is covered by a traditional indemnity health insurance plan that specifies a $250 deductible and includes a 20% coinsurance provision. When Ms. Riva was hospitalized, she incurred $2,500 in medical expenses that were covered by her health plan.

Options:
A.

$1,750

B.

$1,800

C.

$2,000

D.

$2,250

Questions # 7:

The following sentence contains an incomplete statement with two missing words. Select the answer choice that contains the words that correctly fill in the missing blanks.

At its core, consumer choice involves empowering healthcare consumers to play a __

Options:
A.

greater/lesser

B.

greater/greater

C.

lesser/greater

D.

lesser/lesser

Questions # 8:

Phillip Tsai is insured by both a traditional indemnity health insurance plan, which is his primary plan, and a health plan, which is his secondary plan. Both plans have typical coordination of benefits (COB) provisions, but neither has a nonduplication of

Options:
A.

$0

B.

$300

C.

$400

D.

$900

Questions # 9:

Many HMOs are compensated for the delivery of healthcare to members under a prepaid care arrangement. Under a prepaid care arrangement, a plan member typically pays a

Options:
A.

fixed amount in advance for each medical service the member receives

B.

a small fee such as $10 or $15 that a member pays at the time of an office visit to a network provider

C.

a fixed, monthly premium paid in advance of the delivery of medical care that covers most healthcare services that a member might need, no matter how often the member uses medical services

D.

specified amount of the member's medical expenses before any benefits are paid by the HMO

Questions # 10:

Parul Gupta has been covered by a group health plan for eighteen months. For the past four months, she has been undergoing treatment for diabetes. Last week, Ms. Gupta began a new job and immediately enrolled in her new company's group health plan, which

Options:
A.

can exclude coverage for treatment of Ms. Gupta's diabetes for one year, because she did not have at least two years of creditable coverage under her previous health plan

B.

cannot exclude Ms. Gupta's diabetes as a pre-existing condition, because the one-year pre-existing condition provision is offset by at least one year of continuous coverage under her previous health plan

C.

can exclude coverage for treatment of Ms. Gupta's diabetes for one year, because HIPAA does not impact a group health plan's pre-existing condition provision

D.

can exclude coverage for treatment of Ms. Gupta's diabetes for four months, because that is the length of time she received treatment for this medical condition prior to her enrollment in the new health plan

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