HSA 312 Final Exam questions and correct answers| A Grade passed
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Course
HSA
Institution
HSA
Who has final responsibility for all aspects of an independent HMO? - board of directors
Medical Directors typically have responsibility for: - Utilization
management Benefits determination for appeals
Quality managment
What is the most common form of claims submission ? - ✔✔Electronic
What are intermediaries in the employer-sponsored business called? - ✔✔Brokers
and Consultants
Beginning in 2014, what new distribution channel became available? - ✔✔state-level health
insurance exchanges
What is typically considered to be marketing functions? - ✔✔Typical marketing function types
within a larger business might include performing market research, producing a marketing plan,
, and product development, as well as strategically overseeing advertising, promotion, distribution
for sale, customer service and public relations
___ rates are high enough to generate sufficient revenue to cover all claims and other plan
expenses and to yield an acceptable return on equity. - ✔✔adequate
Dependent Coverage is extended to what age under the Affordable Care Act (ACA)? - ✔✔26
____ rating entails the application of a standard rate to all groups within the community being
underwritten - ✔✔Basic community
What is considered a "life event" for insurance enrollment? - ✔✔marriage, retirement, loss of a
loved one or birth of a new baby, and possibly an unexpected relocation
What aspects of the claims capability must be "counted" or measured in order to allocate
adequate resources and verify financial assumptions about an insured population? -
✔✔Inventory receipts & Timely filing limits, Turnaround time based on the date the
MCO received the claim, & Claims lag as well as IBNR.
Is a participating provider permitted to balance bill a member for any copayments, coinsurance,
or deductibles that are applicable to a claim payment ? - ✔✔False
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