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Guide for Medical Management

Quiz Medical Management

Free Test
/ 10

Quiz

1/10
Argument6
The paragraph below contains an incomplete statement. Select the answer choice containing the term that correctly completes the paragraph. Medical management programs often require the analysis of many types of data and information. __________________ is an automated process that analyzes variables to help detect patterns and relationships in the data.
Select the answer
1 correct answer
A.
Unbundling
B.
Outsourcing
C.
Data mining
D.
Drilling down

Quiz

2/10
Argument2
Since its inception, Medicare has undergone a number of changes because of legal and regulatory action. One result of the Balanced Budget Act (BBA) of 1997 has been to
Select the answer
1 correct answer
A.
expand Medicare benefits by mandating coverage for certain preventive services
B.
reduce the number of organizations that can deliver covered services
C.
encourage growth of managed Medicare programs in all markets
D.
increase the number of "zero premium" plans available to Medicare beneficiaries

Quiz

3/10
Argument5
Some health plans administer a questionnaire known as the Behavioral Risk Factor Surveillance System (BRFSS) as part of their health risk assessment (HRA) processes. The following statements are about the BRFSS. If statements (A) through (C) are all correct, select answer choice (D). Otherwise, select the one correct statement.
Select the answer
1 correct answer
A.
This questionnaire was designed specifically for use by health plans.
B.
Each health plan must use the same form of the questionnaire, with no additions or modifications.
C.
This questionnaire monitors the prevalence of the major behavioral risks associated with illness and injury among adults.
D.
All of the above statements are correct.

Quiz

4/10
Argument4
Health plans communicate proposed performance changes through action statements. Select the answer choice containing an action statement that includes all of the required elements.
Select the answer
1 correct answer
A.
The proportion of adult members who are screened for hypertension will increase by ten percent.
B.
Primary care providers (PCPs) will increase the proportion of children under the age of two who are up-to-date on immunizations by seven percent within one year.
C.
The QM program director will evaluate the level of provider compliance with clinical practice guidelines (CPGs).
D.
The disease management program director will increase participation by asthmatic children in the health plan's pediatric asthma disease management program.

Quiz

5/10
Argument3
The following statements describe situations in which health plan members have medical problems that require care. Select the statement that describes a situation in which self-care most likely would not be appropriate.
Select the answer
1 correct answer
A.
Two days after bruising her leg, Avis Bennet notices that the pain from the bruise has increased and that there are red streaks and swelling around the bruised area.
B.
Calvin Dodd has Type II diabetes and requires blood glucose monitoring tests several times each day.
C.
Caroline Evans has severe arthritis that requires regular exercise and oral medication to reduce pain and help her maintain mobility.
D.
Oscar Gracken is recovering from a heart attack and requires ongoing cardiac rehabilitation.

Quiz

6/10
Argument0
The following statements are about risk management for case management. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.
Select the answer
1 correct answer
A.
The use of a signed consent authorization form is consistent with accrediting agency standards for patient privacy and confidentiality of medical information.
B.
Case management that is initiated after a member has incurred substantial medical expenses is more likely to be viewed as a tool to cut costs rather than to improve outcomes.
C.
Health plan documents indicating that any case management delegates are separate, independent entities may reduce an health plan's exposure to risk.
D.
A case management file cannot be used to support the health plan's position in the event of a lawsuit.

Quiz

7/10
Argument1
The following statement(s) can correctly be made about the characteristics of peer review: 1.Peer review is applicable to either single episodes of care or to entire programs of care 2.Most peer review is conducted concurrently 3.Under the Health Care Quality Improvement Program (HCQIP), peer review is required for services furnished to Medicare and Medicaid recipients enrolled in health plans
Select the answer
1 correct answer
A.
All of the above
B.
1 and 2 only
C.
1 and 3 only
D.
2 and 3 only

Quiz

8/10
Argument6
To measure performance for quality management, health plans collect and analyze three types of data: financial data, clinical data, and customer satisfaction data. The following statement(s) can correctly be made about the sources of clinical data: 1.Patient surveys are the most widely used source of disease-specific clinical information 2.Outcomes research studies sponsored by academic institutions and professional organizations have limited usefulness for particular health plans or individual providers 3.The SF-36 and the HSQ-39 (Health Status Questionnaire) surveys address both physical and mental health status
Select the answer
1 correct answer
A.
All of the above
B.
1 and 2 only
C.
2 and 3 only
D.
3 only

Quiz

9/10
Argument2
For this question, if answer choices (A) through (C) are all correct, select answer choice (D). Otherwise, select the one correct answer choice. The QAPI (Quality Assessment Performance Improvement Program) is a Centers for Medicaid and Medicare Services (CMS) initiative designed to strengthen health plans' efforts to protect and improve the health and satisfaction of Medicare beneficiaries. QAPI quality assessment standards apply to
Select the answer
1 correct answer
A.
standard medical-surgical services
B.
mental health and substance abuse services
C.
services offered to Medicare enrollees as optional supplementary benefits
D.
all of the above

Quiz

10/10
Argument5
The Noble Health Plan conducted a cost/benefit analysis of the following four prescription drugs: BenefitCost Drug A$525$350 Drug B$450$250 Drug C$400$200 Drug D$350$100 According to this analysis, the drug that represents the most efficient use of resources is
Select the answer
1 correct answer
A.
Drug A
B.
Drug B
C.
Drug C
D.
Drug D
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Info quiz:

  • Quiz name:Medical Management
  • Total number of questions:163
  • Number of questions for the test:50
  • Pass score:80%

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