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Note: you will get 5+ questions from the pdf directly.. so plz go through the questns wch are at the end of each lesson in the

pdf..

Am not wrtng whole answers for some questions please rember key wrds..

1)which is the fastest ur data txion?

Ans: electronic

2) When are experience-based criteria usually used?

Ans: when research based utilization guidelines are not available.

3) Ethical task force !(chek box)

Ans: ethical education,policy dev/review,case consultation(please refer page num 457 in pdf) .

4) Ethical foundation defin.!!u will get one que from these 4 definatns..concept que too!

Autonomy

Non-malef icence

Beneficence

Justice/equity

Promise k eeping/truthtel l ing

5) please read coinsurance , deductible, copay definitions..and the diff between them..u will get one ques for sure@!

The questin I got is :copay is the amount wch we will pay for every visit and coinsurance is the out of pocket amnt wch will

calculated once the claim is filed? Ans: true

Otherwise u will get drect definition.

6) In some states ppo does not include pos y?

Ans: please ask ur trainer for answr.

7) Hmo act 1973 will include HMO to work in two critical areas?

Ans: financial responsibility and health care delivery

8) If medicare part A patient is hospitalizes den ,wch of the follwng is true?

Optns: A)he will pay copayments daily startng frm the admitng date

B)he wont pay anything from out of pocket for first 65 daz

c)he will pay high dedctble

I dint rem anther optin..

This is a concept question,,I dont knw the answer, ask ur trainer..

9) Emr allows physicians/providers to enter the data ____?

Ans: from the point of site wer servce provided.

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10) ACc to claims admin..claims investigation defi?

11)advantage of medicare part D?

Ans: drug benefits

12) quality management includes____?

Ans: assessment and improvement

13) provider integration order__?

Ans: cmg>ppm>gpww>ipa

14) hmos require federal qualification in order to?

Ans: contract with medicare

15) market research tech?

Ans: focus group

16) reasns for increasing health care costs?

Ans: rapid change in tech,lack of incentives ,cost shifting,inflation etc..see starting lessons of the pdf

17) wch of the following is used to transfer the data all over the network?

Ans: HIN(health infor netwrk)

18) page no 345 qn.7 in pdf

19) if u hav to do both retrospective and prospective revw wch will u prefer?

Ans: prospective

20) percentage discount from physician nominal fees is called as?

Ans: discount ffs

21) wch is not antitrust laws in the folwng?

Ans: antiselection

22) while renewal underwriting wch are taken into consideration?

Ans: experience and participation

23) rating method that is used to decd premiums based on the demographic factors like age, family composition is called as?

Ans: ACR

24) page no 24 ,qu.6, in pdf

25) income statements includes__?

Ans: revenues ,expenses

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26) page no 72,wn.7,in pdf

27) 396,qn.6 in pdf

28) features of pos?

Ans: freedomof choice,cost cutting efforts and pcp

29) wch is not a speciality service of the following?

Ans: plese refer to page no :108

30) managed dental care ?

Ans: >50%

31) medicare consists of the ?

Ans: corporate compliance director

32) pbm cares for quality?

Ans: true

33) who is not covered under regular group model?

Ans: employee not having any insurance

34) primary source verification?

Ans: validation

35) electronic transmission adv?

Ans: fast and less man power,accurate

36) page 254 ,qn.3

37) I didnt remember questn but in the answers the correct optnis PRICE

38) page no 344 qnos1,2,4, page no 345 qno.6,7, page no.360 qno.2,4

39) glb act

40) page 382 qn.2

41)a typical of dental hmo?( U WILL GET THIS QUSTN TWICE )

Ans: no deductuibles

For secnd ques answr is: copay,annual benefits,but no coinsurance or deductible

42) u will get one relates to commitees directly ?

For answ refer: page no 194 medical advisory committee

For this questn u will four blanks..so in the optn medical advsry comitte repeat twice ..be careful see clearly

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43) states will offer premiums instead of covering health plan for?

Optns :for chip only,for medicare only,both

Ask ur trainer for answer.

44) difference between ecommerce and edi?

Ans: edi in batches ,ecommerce is end to forth

45) after surgery a patient does not need to be in hospital but he needs 24hrs care by a nurse ,,watt type of care is this?

Ans: hospital step down care

46) true about small employees?

Ans: they usally have single health plan

47) diff betwn advertising and publicity?

Ans: adv is paid fro,but publicity is not

48) abc company gives same plan for all the emp[loyees?

Ans: community rating

49) comprehnsve carve out payment method?

Ans: capitation

50) TRICARE payment coverage?

ans:ffs

51) true about structure and procedure?

Ans: struc and procedure will produce outcomes

52)encryption means?

53) member satisfaction?

Ans: both complaint monitoring and surveys

54) case management?

Ans: high risk,high cost,chronic deseases

55) if hmo undergoes insolevency then commissioner can take steps?

Ans:Monitoring a corrective plan developed by the HMO.Reducing the volume of new business the HMO can accept.

Taking steps to reduce the HMOs expenses.

Prohibiting the HMO from writing new business for a specified period of time.

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56) medicare part d coverage?

Ans: MA,PDPs

57) pls read TPA act !

58) long term committee responsible for?

Ans: standing commte

59) sachin wants to know about his health plan(has a doubt), so he called to office but the telephone is not wrking/they didnt answer..wat

type of problem is this?

Optns: telephone service problem, health plan problem,etc

Pls ask ur trainer for the anser

60) read about pho

61) claims further investigation.?

Ans: edits

62) one questn related to mso..like..an organization contracted with group of org to provide admin services bla bla

Ans: remember that the organization which provides administration services is called MSO

Another orgztnin the quest would be ppm

63) read about perdiems

64) true about state lwas?

Read about carve outs

65) clinical practice guidelinesu will get two qustn frm this topic

66) u will get one questn from ERISA for sure..

Read about it,, the que is like true bout erisa(chek box)..

67) independent review organization?

Ans: formal committee that reviews.

68) Hipaa type 1

69) always controversy among providers?

Ans: peer review

70) u will get1 or 2 problems on coinsurance..like how much membr pays ,,how much plan pays?

71)there will be concept questns on cobra,,bcoz of time constraint am not wrtng que..plz go through it

Apart from the above questns ,,u will get qustns on utilization review ,physician profiling, clinical guidelines , behavioral health plan,drug

utilization review, IVR, board of dirctors is responsible for?..(sry becoz of less time am nt wrtng questns)

If u read this ,u will defntly passu will get 50 ques for sure..

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