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Network Management

Last Update May 9, 2024
Total Questions : 202

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Last Update May 9, 2024
Total Questions : 202

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Last Update May 9, 2024
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Network Management Questions and Answers

Questions 1

An increasing number of health plans offer coverage for alternative healthcare services. One such alternative healthcare service is biofeedback. Biofeedback is an approach that

Options:

A.

is based on an ancient Chinese system of healing in which needles are inserted into specific sites on the body to relieve pain

B.

treats diseases with tiny doses of substances which, in healthy people, are capable of producing symptoms like those of the disease being treated

C.

uses electronic monitoring devices to teach a patient to develop conscious control of involuntary bodily functions, such as heart rate and body temperature

D.

incorporates a variety of therapies, such as homeopathy, lifestyle modification, and herbal medicines, to support and maintain the body’s ability to heal itself

Questions 2

The Edgewood Health Plan uses a combination of structural, process, outcomes, and customer satisfaction measures to evaluate its network providers’ performance. Edgewood would correctly use outcomes measures to evaluate a provider’s

Options:

A.

Compliance with specific regulatory or accrediting requirement

B.

Appropriate use of specified procedures

C.

Patient progress following treatment

D.

Patient perceptions about how well the provider addresses medical problems

Questions 3

When evaluating the success of providers in meeting standards, a health plan must make adjustments for case mix or severity. One true statement about case mix/severity adjustments is that they:

Options:

A.

Typically are more important in measuring the performance of PCPs than they are in measuring the performance of specialists

B.

Help compensate for any unusual factors that may exist in a provider's patient population or in a particular patient

C.

Tend to increase the number of providers who are considered to be outliers

D.

Allow for a more equitable comparison of data between providers of outpatient care but not providers of inpatient care