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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