#1
Which of the following is a key characteristic of an HMO (Health Maintenance Organization) in managed care?
Open access to any healthcare provider
Requires a primary care physician (PCP)
No network restrictions
Direct access to specialists
#2
What role does utilization management play in managed care?
Ensuring healthcare providers have unlimited access to resources
Reviewing and managing the appropriate use of healthcare services
Limiting patient access to necessary medical care
Providing financial incentives to healthcare providers
#3
What is the primary focus of a gatekeeper in the context of managed care?
Providing emergency medical care
Controlling access to specialty care and healthcare services
Setting insurance premium rates
Conducting medical research
#4
Which federal program provides health coverage for low-income individuals and families, and is jointly funded by federal and state governments in the United States?
Medicare
Medicaid
CHIP (Children's Health Insurance Program)
TRICARE
#5
What is the primary function of a Pharmacy Benefit Manager (PBM) in managed care?
Provide emergency medical care
Coordinate care between healthcare providers
Manage prescription drug benefits
Enforce healthcare regulations
#6
In a PPO (Preferred Provider Organization), what is a significant feature that distinguishes it from other managed care models?
No copayments required
Strict requirement for referrals
Flexibility to see out-of-network providers
Limited coverage for preventive services
#7
What is the primary goal of case management in managed care?
Minimize patient interaction with healthcare providers
Maximize the use of expensive diagnostic tests
Coordinate and optimize healthcare services for cost-effective outcomes
Focus solely on inpatient care
#8
Which of the following is a characteristic of a Health Savings Account (HSA) in the context of managed care?
Contributions are tax-deductible
Managed by the government
Withdrawals are tax-free only for non-medical expenses
No contribution limits
#9
What is the primary focus of disease management programs in managed care?
Preventive measures for healthy individuals
Management of chronic conditions for improved outcomes
Exclusive coverage for catastrophic illnesses
Short-term acute care interventions
#10
Which regulatory body oversees and enforces compliance with the Affordable Care Act (ACA) in the United States?
Centers for Medicare & Medicaid Services (CMS)
Food and Drug Administration (FDA)
Occupational Safety and Health Administration (OSHA)
Internal Revenue Service (IRS)
#11
Which type of managed care model is characterized by both HMO and PPO features, allowing members to choose between in-network and out-of-network providers?
Exclusive Provider Organization (EPO)
Point of Service (POS)
Indemnity Insurance
Capitation Model
#12
In the context of managed care, what is the term for a fixed amount paid by the patient for covered services at the time of service?
Premium
Deductible
Coinsurance
Copayment
#13
In managed care, what is the primary purpose of a formulary?
To determine the coverage of cosmetic procedures
To list preferred medications and control costs
To track patient medical history
To regulate the length of hospital stays
#14
Which financial arrangement involves a fixed monthly payment per enrollee, regardless of the services provided, and is commonly used in HMOs?
Capitation
Fee-for-service
Bundled payments
Risk-based contracting
#15
What is the term for a healthcare delivery system that integrates the financing and delivery of appropriate healthcare services to covered individuals?
Managed care
Fee-for-service
Universal healthcare
Telehealth