QUESTION: 161

Ronald Canton is a member of the Omega MCO. He receives his nonemergency medical care from Dr. Kristen High, an internist.
When Mr. Canton needed to visit a cardiologist about his irregular heartbeat, he first had to obtain a referral from Dr. High to see

Dr. High serves as the coordinator of care for the medical services that Mr. Canton receives.
Omega's network of providers includes Dr. High, but not Dr. Miller.
Omega's system allows its members open access to all of Omega's participating providers.
Omega used a financing arrangement known as a relative value scale (RVS) to compensate Dr.
Miller.

Answer(s): A

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QUESTION: 162

Several marketplace factors helped fuel the movement toward consumer choice.
Which one of the following statements is NOT accurate with regard to these factors?

After a period of relative stability, annual growth in private health spending per capita began to increase rapidly in 2002.
During the height of the recent cost upswing, insurance premiums were increasing by more than 13% annually.
Increased utilization was the largest factor contributing to the rise in premiums, accounting for 43% of the increase.
Employer payers began seeking ways to control spiraling utilization rates and provide lower cost health coverage options.

Answer(s): A

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QUESTION: 163

Some providers use electronic medical records (EMRs) to document their patients' care in an electronic form. The following statement(s) can correctly be made about EMRs:

EMRs are computerized records of a patient's clinical, demographic, and administrator
B only
Both A and B
Neither A nor B
A only

Answer(s): D

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QUESTION: 164

Some states mandate that an independent enrollment broker or benefits counselor contractor selected by the state must manage enrollment of the eligible Medicaid population into managed care. In other states a health plan can engage independent brokers and

Many states have regulations that prohibit health plans from using door-to-door and/or telephone solicitation to market health plan products to the Medicaid population.
Health plans are never allowed to medically underwrite individual market customers who are under age 65.
To promote a health plan product to the individual market, health plans typically use captive agents who give sales presentations to potential customers, rather than using promotion tools such as direct mail, telemarketing, or advertising.
Health plans typically are allowed to medically underwrite all individual market customers who are covered by Medicare and can refuse to cover such customers.

Answer(s): A

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QUESTION: 161

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QUESTION: 163

QUESTION: 164

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