QUESTION: 1

The following statements describe two types, or models, of HMOs:
The Quest HMO has contracted with only one multi-specialty group of physicians. These physicians are employees of the group practice, have an equity interest in the practice, and provide

A captive group a staff model
A captive group a network model
An independent group a network model
An independent group a staff model

Answer(s): B

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QUESTION: 2

______________ HMOs can't medically underwrite any group incl small groups.

State
Not-for-profit
For-profit
Federally qualified

Answer(s): B

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QUESTION: 3

A common physician-only integrated model is a group practice without walls (GPWW). One characteristic of a typical GPWW is that the

GPWW combines multiple independent physician practices under one umbrella organization
GPWW generally has a lesser degree of integration than does an IPA
member physicians cannot own the GPWW
GPWW's member physicians must perform their own business operations

Answer(s): A

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QUESTION: 4

A health plan may use one of several types of community rating methods to set premiums for a health plan. The following statements are about community rating. Select the answer choice containing the correct statement.

Standard (pure) community rating is typically used for large groups because it is the most competitive rating method for large groups.
Under standard (pure) community rating, a health plan charges all employers or other group sponsors the same dollar amount for a given level of medical benefits or health plan, without adjusting for factors such as age, gender, or experience.
In using the adjusted community rating (ACR) method, a health plan must consider the actual experience of a group in developing premium rates for that group.
The Centers for Medicare and Medicaid Services (CMS) prohibits health plans that assume Medicare risk from using the adjusted community rating (ACR) me

Answer(s): B

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