Instructions

What is the term for an MCO that serves Medicare beneficiaries?

  • A. Part A
  • B. Medicare Advantage
  • C. Social Foundation
  • D. Exclusive Provider Organization

2. Which of the following types of care represent healthcare services delivered by MCOs?

  • A. Preventive
  • B. Wellness-oriented
  • C. Chronic
  • D. A and B only
  • E. All of the above

3. All of the following types of services or populations are common examples of “carve outs” EXCEPT:

  • A. Dental care
  • B. Prescription drugs
  • C. Immunizations and well-baby care
  • D. Behavioral and mental health
  • E. Chronically ill children

4. Who are “dual eligibles”?

  • A. Individuals who are eligible for Medicare and are institutionalized
  • B. Individuals who are eligible for Medicare and have Long-Term care insurance
  • C. Individuals who are eligible for Medicare and Medicaid
  • D. Individuals who are eligible for Medicare and have a severe or disabling chronic condition

5. For what reasons do MCOs survey their members for feedback?

  • A. To determine their satisfaction with services
  • B. To obtain their perceptions of the plan’s strengths and weaknesses and their suggestions for improvements
  • C. To learn their intentions regarding reenrolling in the plan
  • D. A and B only
  • E. All of the above

6. All of the following services are typically reviewed for medical necessity and utilization EXCEPT:

  • A. Inpatient admissions
  • B. Well-baby check
  • C. Mental health and chemical dependency care
  • D. Rehabilitative therapies

7. In which type of HMO are the physicians employees?

  • A. Network model
  • B. Group practice model
  • C. Independent practice association (IPA) model
  • D. Staff model

8. All of the following activities are steps in medical necessity and utilization review EXCEPT:

  • A. Peer clinical review
  • B. Appeal consideration
  • C. Initial clinical review
  • D. Administrative review

9, Which of the following types of care represent healthcare services not delivered by MCOs?

  • A. Experimental devices
  • B. Preventive
  • C. Chronic
  • D. Acute illness

10. What is the term that means evaluating, for a healthcare service, the appropriateness of its setting and its level of service?

  • A. Outcomes assessment
  • B. Community rating
  • C. Utilization review
  • D. Coordination of service benefits

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