Q1. The Westchester Health Plan is using a pricing strategy that involves setting a low price in a highly price-sensitive market to stimulate revenue growth. In following this strategy, Westchester is sacrificing short-term profits for fast growth in selected markets. This information indicates that Westchester is following the pricing strategy known as
A.Market skimming
B. Buying market share
C. Price skimming
D. Unitary pricing
Correct Answer: B
Q2. In examining accountability in the current managed care environment, one is likely to find that combinations of various models of accountability are in operation. Under one model of accountability, the primary mechanisms for accountability are the mechanisms of the marketplace failure to meet standards will result in a loss of demand for services. By definition, this model of accountability is called the
A.Professional model of accountability
B. Political model of accountability
C. Due diligence model of accountability
D. Economic model of accountability
Correct Answer: D
Q3. SoundCare Health Services, a health plan, recently conducted a situation analysis. One step in this analysis required SoundCare to examine its current activities, its strengths and weaknesses, and its ability to respond to potential threats and opportunities in the environment. This activity provided SoundCare with a realistic appraisal of its capabilities. One weakness that SoundCare identified during this process was that it lacked an effective program for preventing and detecting violations of law. SoundCare decided to remedy this weakness by using the 1991 Federal Sentencing Guidelines for Organizations as a model for its compliance program. With respect to the Federal Sentencing Guidelines, actions that SoundCare should take in developing its compliance program include
A.Creating a system through which employees and other agents can report suspected misconduct without fear of retribution
B. Holding management accountable for the misconduct of their subordinates
C. Assigning a high-level member of management to the position of compliance coordinator or administrator
D. All of the above
Correct Answer: D
Q4. The Hanford Health Plan has delegated the credentialing of its providers to the Sienna Group, a credential verification organization (CVO). If the contract between Hanford and Sienna complies with all of the National Committee for Quality Assurance (NCQA) guidelines for delegation of credentialing, then this contract
A.Transfers to Sienna all rights to terminate or suspend individual practitioners or providers in Hanford's provider network
B. Describes the process by which Hanford evaluates Sienna's performance in credentialing providers
C. Both A and B
D. A only
E. B only
F. Neither A nor B
Correct Answer: C
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