Health plans' use of the Internet to provide plan members with health-related information has grown rapidly in recent years. One advantage the Internet has over other forms of communication is that

A. users can access the Internet using a number of different types of computer systems

B. access to the Internet is available only to members of the health plan's network

C. the Internet is immune to internal security breaches by employees or trading partners within the network

D. users can contact a single controlling organization to rectify disruptions in Internet service

Employer-sponsored benefit plans that provide healthcare benefits must comply with the Employee Retirement Income Security Act (ERISA). One of the most significant features of ERISA is that it

A. contains a provision stating that the terms of ERISA generally take precedence over any state laws that regulate employee welfare benefit plans

B. standardizes the conversion of group healthcare benefits to individual healthcare benefits

C. mandates that self-funded healthcare plans must pay state premium taxes

D. requires that all active employees, regardless of age, must be eligible for coverage under employer-sponsored benefit plans

Arthur Moyer is covered under his employer's group health plan, which must comply with the Consolidated Omnibus Budget Reconciliation Act (COBRA). Mr. Moyer is terminating his employment. He has elected to continue his coverage under his employer's group

A. 18 months, but his coverage under COBRA will cease if he obtains group health coverage through another employer.

B. 18 months, even if he obtains group health coverage through another employer.

C. 36 months, but his coverage under COBRA will cease if he obtains group health coverage through another employer.

D. 36 months, even if he obtains group health coverage through another employer.

In certain situations, a health plan can use the results of utilization review to intervene, if necessary, to alter the course of a plan member's medical care.

A. Such intervention can be based on the results of

B. Prospective review

C. Concurrent review

A. A, B, and C

B. A and B only

C. A and C only

D. B only

Primary care case managers (PCCMs) provide case management services to eligible Medicaid recipients. With regard to PCCMs it is correct to say that:

A. PCCMs typically receive a case management fee, rather than reimbursement for medical services on a FFS basis, for the services they provide to Medicaid recipients.

B. All Medicaid recipients who live in rural areas must be given a choice of at least four PCCMs.

C. PCCMs receive a case management fee in addition to reimbursement for medical services on a FFS basis.

D. PCCMs contract directly with the federal government to provide case management services to Medicaid recipients.

Some providers use electronic medical records (EMRs) to document their patients' care in an electronic form. The following statement(s) can correctly be made about EMRs:

A. EMRs are computerized records of a patient's clinical, demographic, and administrator

B. B only

C. Both A and B

D. Neither A nor B

E. A only

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

A. less cumbersome and labor intensive

B. faster and more accurate

C. more acceptable to physicians

D. subject to greater scrutiny by regulatory bodies

The Gable MCO sometimes experience-rates small groups by underwriting a number of small groups as if they constituted one large group and then evaluating the experience of the entire large group. This practice, which allows small groups to take advantage

A. prospective experience rating

B. pooling

C. retrospective experience rating

D. positioning

The Hill Health Plan designed a set of benefits that it packaged in the form of a PPO product. Hill then established a pricing structure that allowed its product to compete in the small group market, and it developed advertising designed to inform potential

A. $140

B. $170

C. $180

D. $210

Two MCOs in a single service area divided purchasers into two groups and agreed to each market their products to only one purchaser group. This information indicates that these two MCOs violated antitrust requirements because they engaged in an activity key

A. horizontal group boycott

B. horizontal division of markets

C. a tying arrangement

D. price fixing