Question 1

The following statement(s) can correctly be made about hospitalists.

1. The hospitalist’s main function is to coordinate diagnostic and treatment activities to ensure that

the patient receives appropriate care while in the hospital.

2. The hospitalist’s role clearly supports the health plan concept of disease management.

Options :

A : Both 1 and 2

B : 1 only

C : 2 only

D : Neither 1 nor 2

Answer: B

Question 2

The following statements are about workers' compensation provider networks. Select the answer choice containing the correct statement:

Options :

A :

In order to supply a provider network to furnish healthcare to workers' compensation beneficiaries, a health plan typically uses the network that has already been created for the group health plan.

B : Typically, case managers for workers' compensation programs are physical therapists.

C :

Most states prohibit the use of fee schedules in order to curb the rising workers' compensation healthcare costs.

D :

Networks serving workers' compensation patients typically include higher concentrations of specialists than do other provider networks.

Answer: D

Question 3

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 4

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 5

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