- (Topic 2)
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

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

Correct Answer: C

- (Topic 1)
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, M.D., in an effort to recruit her as a PCP in Green

1. A. Greentree is prevented by law from offering a contract to D
2. B. Cortelyou until the credentialing process is complete
3. C. any contract signed by D
4. D. 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
5. E. Greentree must offer a standard contract to D
6. F. Cortelyou, without regard to the outcome of the credentialing process
7. G. Greentree will abandon the credentialing process now that D
8. H. Cortelyou has agreed to participate in Greentree's network

Correct Answer: B

- (Topic 2)
Patrick Flaherty's employer has contracted to receive healthcare for its employees from the Abundant Healthcare System. Mr. Flaherty visits his primary care physician (PCP), who sends him to have some blood tests. The PCP then refers Mr. Flaherty to a special

1. A. an integrated delivery system (IDS)
2. B. a Management Services Organization (MSO)
3. C. a Physician Practice Management (PPM) company
4. D. a physician-hospital organization (PHO)

Correct Answer: A

- (Topic 2)
One characteristic of the accreditation process for MCOs is that

1. A. an accrediting agency typically conducts an on-site review of an MCO's operations, but it does not review an MCO's medical records or assess its member service systems
2. B. each accrediting organization has its own standards of accreditation
3. C. the accrediting process is mandatory for all MCOs
4. D. government agencies conduct all accreditation activities for MCOs

Correct Answer: B

- (Topic 2)
The prudent layperson standard described in the Balanced Budget Act (BBA) of 1997 requires all hospitals that receive Medicare or Medicaid reimbursement to screen and, if necessary, stabilize all patients who come to their emergency departments.

1. A. True
2. B. False

Correct Answer: B