QUESTION: 97

In the following sections, we will describe some of the measures health plans use to evaluate the quality of the services and healthcare they offer their members.
Which of the following is the best description of what a 'Process measure' evaluates?

The nature, quantity, and quality of the resources that a health plan has available for member service and patient care.
The methods and procedures a health plan and its providers use to furnish service and care.
The extent to which services succeed in improving or maintaining satisfaction and patient health.
None of the above

Answer(s): B

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QUESTION: 98

In the paragraph below, a sentence contains two pairs of words enclosed in parentheses. Determine which word in each pair correctly completes the sentence. Then select the answer choice containing the two words that you have chosen. Many pharmacy benefit

Therapeutic / always
Generic / always
Generic / never
Therapeutic / never

Answer(s): A

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QUESTION: 99

In the paragraph below, two statements each contain a pair of terms enclosed in parentheses. Determine which term correctly completes each statement. Then select the answer choice containing the two terms that you have chosen. For providers, (operational /

operational / an acquisition
operational / a consolidation
structural / an acquisition
structural / a consolidation

Answer(s): D

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QUESTION: 100

In the United States, the Department of Defense offers ongoing healthcare coverage to military personnel and their families through the TRICARE health plan. One true statement about TRICARE is that

hospitals participating in TRICARE program are exempt from JCAHO accreditation and Medicare certification
TRICARE enrollees are not entitled to appeal authorization coverage decisions
active duty personnel are automatically considered enrolled in TRICARE Prime
TRICARE covers inpatient and outpatient services, physician and hospital charges, and medical supplies, but not mental health services

Answer(s): C

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QUESTION: 100