Question 1

Health plans that offer healthcare programs for Medicare beneficiaries have a strong financial incentive for identifying high-risk seniors as early as possible. The identification of high-risk seniors is typically accomplished through the use of

Options :

A : case management

B : geriatric evaluation and management (GEM)

C : intervention identification

D : interdisciplinary home care (IHC)

Answer: C

Question 2

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 3

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 4

One true statement about state regulation of case management activities is that the majority of states

Options :

A :

have enacted laws that list specific quality management requirements for a case management program

B :

consider case management files to be medical records that must be retained for a specified length of time

C : view case management similarly and follow similar patterns with their laws and regulations

D : have enacted laws or regulations requiring licensure or certification of case managers

Answer: B

Question 5

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