Network Management Practice Questions

In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA), which increased the continuity and portability of health insurance coverage. One statement that can correctly be made about HIPAA is that it: A.Applies to group health insurance plans only.B.Limits the length of a health plan's pre-existing condition exclusion period for a previously covered individual to a maximum of six months after enrollment.C.Guarantees access to healthcare coverage for small businesses and previously covered individuals who meet specified eligibility requirements.D.Guarantees renewability of group and individual health coverage, provided the insureds are still in good health.

After HIPAA was enacted, Congress amended the law to include the Mental Health Parity Act (MHPA) of 1996, a federal requirement relating to mental health benefits. One true statement about the MHPA is that it: A.requires all health plans to provide coverage for mental health servicesB.requires health plans to carve out mental/behavioral healthcare from other services provided by the plansC.allows health plans to require patients receiving mental health services to pay higher copayments than patients seeking treatment for physical illnessesD.prohibits health plans that offer mental health benefits from applying more restrictive limits on coverage for mental illness than on coverage for physical illness

From the following answer choices, choose the term that best matches the description.An integrated delivery system (IDS), which controls most providers in a particular specialty, agrees to provide that specialty service to a health plan only on the condition that the health plan agree to contract with the IDS for other services. A.Group boycottB.Horizontal division of territoriesC.Tying arrangementsD.Concerted refusal to admit

By definition, a measure of the extent to which a health plan member can obtain necessary medical services in a timely manner is known as: A.Network managementB.QualityC.Cost-effectivenessD.Accessibility

Decide whether the following statement is true or false:The organizational structure of a health plan's network management function often depends on the size and geographic scope of the health plan. With respect to the size of a health plan, it is correct to say that smaller health plans typically have less integration and more specialization of roles than do larger health plans. A.TrueB.False