Question 1

With respect to hiring practices, one step that a health plan most likely can take to avoid violating the terms of the Americans with Disabilities Act (ADA) is to

Options :

A : Require a medical examination prior to accepting an application for employment

B : Include in the employment application questions pertaining to health status

C :

Make a conditional offer of employment, and then require the candidate to have an examination prior to granting specific staff privileges

D : Require applicants to answer questions pertaining to the use of drugs and alcohol

Answer: C

Question 2

The following statements are about workers' compensation provider networks. Select the answer choice containing the correct statement:

Options :

A :

In order to supply a provider network to furnish healthcare to workers' compensation beneficiaries, a health plan typically uses the network that has already been created for the group health plan.

B : Typically, case managers for workers' compensation programs are physical therapists.

C :

Most states prohibit the use of fee schedules in order to curb the rising workers' compensation healthcare costs.

D :

Networks serving workers' compensation patients typically include higher concentrations of specialists than do other provider networks.

Answer: D

Question 3

The following statements are about the negotiation process of provider contracting. Three of the statements are true and one of the statements is false. Select the answer choice containing the FALSE statement.

Options :

A :

While preparing for negotiations, the health plan usually sends the provider an application to join the provider network, a list of credentialing requirements, and a copy of the proposed provider contract, which may or may not include the proposed reimbursement schedule

B : In general, the ideal negotiating style for provider contracting is a collaborative approach.

C :

Typically, the health plan and the provider negotiate the reimbursement arrangement between the parties before they negotiate the scope of services and the contract language.

D :

The actual signing of the provider contract typically takes place after negotiations are completed.

Answer: C

Question 4

The provider contract that the Canyon health plan has with Dr. Nicole Enberg specifies that she

cannot sue or file any claims against a Canyon plan member for covered services, even if Canyon

becomes insolvent or fails to meet its financial obligations. The contract also specifies that Canyon

will compensate her under a typical discounted fee-for-service (DFFS) payment system.

During its recredentialing of Dr. Enberg, Canyon developed a report that helped the health plan

determine how well she met Canyon's standards. The report included cumulative performance

data for Dr. Enberg and encompassed all measurable aspects of her performance. This report

included such information as the number of hospital admissions Dr. Enberg had and the number of

referrals she made outside of Canyon's provider network during a specified period. Canyon also

used process measures, structural measures, and outcomes measures to evaluate Dr. Enberg's

performance.

The clause which specifies that Dr. Enberg cannot sue or file any claims against a Canyon plan

member for covered services is known as:

Options :

A : Atermination with cause clause

B : Ahold-harmless clause

C : An indemnification clause

D : Acorrective action clause

Answer: B

Question 5

With respect to contractual provisions related to provider-patient communications, nonsolicitation clauses prohibit providers from

Options :

A : Encouraging patients to switch from one health plan to another

B : Disclosing confidential information about the health plan’s reimbursement structure

C : Dispersing confidential financial information regarding the health plan

D : Discussing alternative treatment plans with patients

Answer: A

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