QUESTION: 61

From the following choices, choose the definition that best matches the term Screening

A technique used to educate plan members on how to distinguish between minor problems and serious conditions and effectively treat minor problems themselves
A technique used to determine if a health condition is present even if a member has not experienced symptoms of the problem
A technique in which information about a plan member's health status, personal and family health history, and health-related behaviors is used to predict the member's likelihood of experiencing specific illnesses or injuries
A technique used to evaluate the medical necessity, appropriateness, and cost-effectiveness of healthcare services for a given patient

Answer(s): B

General HMO is building a provider network and is considering Universal Hospital as an addition to its network. Minimum requirements that General should consider in determining whether Universal is qualified to participate in General's network include A,

Both A and B
A only
B only
Neither A nor B

Answer(s): A

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QUESTION: 63

Greentree Medical, a health plan, is currently recruiting PCPs in preparation for its expansion into a new service area. Abigail Davis, a recruiter for Greentree, has been meeting with Melissa Cortelyou,

D., in an effort to recruit her as a PCP in Green
Greentree is prevented by law from offering a contract to Dr. Cortelyou until the credentialing process is complete
any contract signed by Dr. Cortelyou should include a clause requiring the successful completion of the credentialing process within a defined time frame in order for the contract to be effective
Greentree must offer a standard contract to Dr. Cortelyou, without regard to the outcome of the credentialing process
Greentree will abandon the credentialing process now that Dr. Cortelyou has agreed to participate in Greentree's network

Answer(s): B

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QUESTION: 64

Health plans can organize under a not-for-profit form or a for-profit form. One true statement regarding not-for-profit health plans is that these organizations typically

are exempt from review by the Internal Revenue Service (IRS)
are organized as stock companies for greater flexibility in raising capital
rely on income from operations for the large cash outlays needed to fund long-term projects and expansion
engage in lobbying or political activities in order to maintain their tax-exempt status

Answer(s): C

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QUESTION: 64