Question 1

The Walnut Health Plan provides a number of specialty services for its members. Walnut offers coverage of alternative healthcare, including coverage of treatment methods such as homeopathy and naturopathy. Walnut also offers home healthcare services, and it contracts with home healthcare providers on a non-risk basis to the health plan. The following statements are about the specialty services offered by Walnut. Select the answer choice containing the correct statement:

Options :

A :

Homeopathy treats diseases by using small doses of substances which, in healthy people, are capable of producing symptoms like those of the disease being treated.

B :

Naturopathy is an approach to healthcare that uses electronic monitoring devices to teach a patient to develop conscious control of involuntary bodily functions, such as heart rate.

C :

Under a non-risk contract, Walnut most likely transfers the responsibility for arranging home healthcare to the home healthcare provider organizations.

D :

Federal law allows Walnut to contract with a home healthcare provider organization only if the provider organization has received accreditation by the Utilization Review Accreditation Commission (URAC).

Answer: A

Question 2

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

Question 3

The following statement(s) can correctly be made about hospitalists.

1. The hospitalist’s main function is to coordinate diagnostic and treatment activities to ensure that

the patient receives appropriate care while in the hospital.

2. The hospitalist’s role clearly supports the health plan concept of disease management.

Options :

A : Both 1 and 2

B : 1 only

C : 2 only

D : Neither 1 nor 2

Answer: B

Question 4

Medicaid beneficiaries pose a challenge for health plans attempting to establish Medicaid provider networks. Compared to membership in commercial health plans, Medicaid enrollees typically

Options :

A : Require access to greater numbers of obstetricians and pediatricians

B : Have stronger relationships with primary care providers

C : Are less reliant on emergency rooms as a source of first-line care

D : Need fewer support and ancillary services

Answer: A

Question 5

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

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