AHM-510 Governance, Legal Issues, Medicare & Medicaid Practice Questions

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 networkB.Describes the process by which Hanford evaluates Sienna's performance in credentialing providersC.Both A and BD.A onlyE.B onlyF.Neither A nor B

Congress enacted three clauses relating to the preemptive effect of the Employee Retirement Income Security Act of 1974 (ERISA). One of these clauses preserves from ERISA preemption any state law that regulates insurance, banking, or securities, with the exception of the exemption for self-funded employee benefit plans. This clause is called the: A.Savings clauseB.Preemption clauseC.Deemer clauseD.De novo clause

Any willing provider laws have their share of proponents and opponents. Arguments commonly made in opposition to any willing provider laws include: A.That such laws reduce the number of providers in a health plan's networkB.That such laws limit consumer choice to coverage options that are more costly than network based plansC.That such laws encourage providers to offer discounts in exchange for patient volumeD.All of the above

From the following answer choices, choose the term that best corresponds to this description. Barrington Health Services, Inc. contracts with a state Medicaid agency as a fiscal intermediary. Barrington does not provide medical services, but contracts with medical providers on behalf of the state Medicaid agency. A.Health insuring organization (HIO)B.Independent practice association (IPA)C.Physician practice management (PPM) companyD.Peer review organization (PRO)