HSM 420 Midterm Exam

DeVry HSM 420 Midterm Exam
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https://devryfinalexams.com/products/hsm-420-midterm-exam/
1. (TCO 1) Why were the first proto-HMOs formed in America? What were the original driving factors in
the HMO movement? (Points : 20)
2. (TCO 1) What is meant by indemnity coverage, and how does it change in managed indemnity?
(Points : 20)
3. (TCO 2) What is the role of the executive director in a managed care organization? Could you see
yourself practicing in this position at some point in your career? Why or why not? (Points : 20)
4. (TCO 2) What is the role of the Peer Review Committee in a managed care organization? And why is
this function so crucial? (Points : 20)
5. (TCO 3) Describe the calculation of capitated payments. How are these rates determined in managed
care organizations? (Points : 20)
6. (TCO 3) Describe the use of evidence-based clinical criteria in managed care. Why is this process so
important in managed care today? (Points : 20)
7. (TCO 4) What is meant by pattern review under managed care? Why do payers conduct pattern
review, and what kinds of things might they identify during such reviews? (Points : 20)
8. (TCO 4) Discuss some key general aspects of physician practice behavior? Include implicit messages
from training, and also environmental factors, in your answer. (Points : 20)
9. (TCO 7) What is the purpose of hold-harmless and balance-billing clauses in managed care contracts?
(Points : 20)
10. (TCO 7) What is typically covered under “term, suspension, and termination” of a managed care
contract? (Points : 20)
DeVry HSM 420 Midterm Exam
Click on the link below for the solution:
https://devryfinalexams.com/products/hsm-420-midterm-exam/