- (Topic 1)
Health savings accounts were created by which of the following laws:

1. A. COBRA
2. B. HIPAA
3. C. Medicare Modernization Act
4. D. None of the Above

Correct Answer: C

- (Topic 3)
Utilization data can be transmitted to the health plan manually, by telephone, or electronically. Compared to other methods of data transmittal, manual transmittal is generally

1. A. less cumbersome and labor intensive
2. B. faster and more accurate
3. C. more acceptable to physicians
4. D. subject to greater scrutiny by regulatory bodies

Correct Answer: C

- (Topic 1)
Dr. Julia Phram is a cardiologist under contract to Holcomb HMO, Inc., a typical closed- panel plan. The following statements are about this situation. Select the answer choice containing the correct statement.

1. A. All members of Holcomb HMO must select D
2. B. Phram as their primary care physician (PCP).
3. C. Any physician who meets Holcomb's standards of care is eligible to contract with Holcomb HMO as a provider.
4. D. D
5. E. Phram is either an employee of Holcomb HMO or belongs to a group of physicians that has contracted with Holcomb HMO
6. F. Holcomb HMO plan members may self-refer to D
7. G. Phram at full benefits without first obtaining a referral from their PCPs.

Correct Answer: A

- (Topic 3)
The measures used to evaluate healthcare quality are generally divided into three categories: process, structure and outcomes. An example of a process measure that can be used to evaluate an MCO's performance is the

1. A. percentage of board certified physicians within the MCO's network
2. B. number of hospital admissions for plan members with certain medical conditions
3. C. number of plan members contracting an infection in the hospital
4. D. percentage of adult plan members who receive regular medical checkups

Correct Answer: D

- (Topic 2)
One factor the Sandpiper Health Plan uses to assess its quality is a clinician's bedside manner, i.e., how friendly and understanding the clinician is, whether the patient feels that the clinician listens to the patient's concerns, how well the clinical

1. A. a provider service quality issue
2. B. an administrative service quality issue a healthcare process quality issue
3. C. a healthcare outcomes quality issue
4. D. a healthcare process quality issue

Correct Answer: A