CME Test Class 7  --  form for test completion

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If you are registered, please use the following form to complete the test from the questions listed on the CME Test  Class 7 (below): 

1.    Dr. Jones is about to enter into a managed care contract with a HMO.  Besides having her attorney review the contract, what should Dr. Jones consider?  (Reference Class 7, "PCP Contracts" - "Typical Managed Care Organization's Structure for Contracting With Primary Care Physicians")

Question 1 choices:

A B C D E 

A.    Dr. Jones does not need her attorney to review the contract because the contract is "boilerplate" and none of the terms are negotiable.

B.    Dr. Jones should carefully review the contract and remember that the HMO might try to make the terms broadly worded and one-sided in their favor.

C.    Dr. Jones does not need to have any concerns about the contract because the HMO is always looking out for her best interest.

D.    Dr. Jones does not need to understand the financial implications of the contract on her medical practice or the utilization management techniques used by the HMO as specified in the contract.

E.    None of the above.

2.   Why would physicians care about the Utilization Review (UR) and Quality Assurance (QA) provisions in a managed care contract they are considering entering into?  (Reference Class 7, "UR/QA/UM" - "Utilization Review ("UR")/ Quality Assurance ("QA")/ Utilization Managment ("UM")   

Question 2 choices:

A B C D E    

A.   Physicians typically do not have any UR or QA type of provisions in their contracts with managed care organizations.

B.   Because most physicians do not have any negotiating power with managed care organizations, they enter into any agreement given to them by any managed care organization and are not concerned about UR or QA type of provisions.

C.   Physicians usually seek to see Utilization Review ("UR") and Quality Assurance ("QA") procedures in advance to determine if they are reasonable and feasible and they may seek to receive adequate notice before any procedures are amended and to terminate contract if they do not accept any new procedure to be imposed.

D.   Physicians are concerned about UR and QA type of provisions because it effects their continuing medical education credits.

E.   None of the above.

3.   What factors does success in specialty service contracting depends on?  (Reference Class 7, "Specialists" - "Specialty Service Contracting")

Question 3 choices:

A B C D E  

A.    Finding the right partner (customer)

B.    Selecting the right service

C.    Setting the right price

D.    Implementation (Running an efficient operation

E.    All of the above.

4.    What is the purpose of "hold harmless" type of provisions in HMO contracts with hospitals?  (Reference Class 7, "PCP Contracts" - "Typical Managed Care Organization's Structure for Contracting With Primary Care Physicians")

Question 4 choices:

A B C D E 

A.   Hold harmless type of provisions in HMO contracts with hospitals prevents hospitals from seeking payment from HMO members for "Covered Services" rendered by the hospital, even if the HMO does not pay for these services, or if the HMO goes bankrupt. This clause does not prevent the hospital from looking to the HMO for payment, but this clause prevents the hospital from looking to the HMO’s members for payment for covered services. If the hospital is looking for payment for services not covered by the HMO that were rendered to an HMO Member, then the hospital can seek payment directly from the member for those type of services ("Self-Pay Situation where services provided are not covered by the HMO contract). 

B.   There is no such thing as "hold harmless" type of provisions in HMO contracts with hospitals.

C.   The purpose of "hold harmless" type of provisions in HMO contracts with hospitals is to prevent employer groups from seeking information that would otherwise be considered confidential.

D.   The purpose of "hold harmless" type of provisions in HMO contracts is to allow HMOs to charge any premium dollar amount they may choose. 

E.   None of the above.

5.   Why is it important for physicians to specify the services they are required to render under contracts with HMOs?  (Reference Class 7, "Basics" - "Basic Contract Structure")

Question 5 choices:

A B C D E 

A.   HMOs may attempt to broadly define the services physicians are to provide under the contract.

B.   Physicians do not need to specify the services they will provide in their contracts with HMOs.

C.   Physicians only need to specify the type of services that are "carved-out" of the contract with HMOs.

D.   Physicians only need to specify the stop-loss amounts in their contracts with HMOs.

E.   None of the above.

6.   Why would physician groups consider purchasing reinsurance or having stop-loss type of provisions in their risk-bearing managed care contracts?  (Reference Class 7, "Basics" - "Basic Contract Structure")

Question 6 choices :

A B C D E 

A.   Physician groups would never consider purchasing reinsurance or having stop-loss type of provisions in their risk-bearing managed care contracts.

B.   Physician groups would consider purchasing reinsurance or having stop-loss type of provisions in their risk-bearing managed care contracts to encourage medical record confidentiality.

C.   Physician groups would consider purchasing reinsurance or having stop-loss type of provisions in their risk-bearing managed care contracts to protect themselves if there are material shifts in factors that influence medical costs.

D.   Physician groups would consider purchasing reinsurance or having stop-loss type of provisions in their risk-bearing managed care contracts to prevent medical malpractice lawsuits.

E.   None of the above.

7.   What are some factors that may effect capitation rates or year end bonuses that physicians may receive?  (Reference Class 7, "Payment" - "Payment Mechanisms")

Question 7 choices:

A B C D E

A.   All physicians are always paid the same amount for both capitation and bonuses by managed care organizations.

B.   Physicians may get different capitation rates or year end bonuses based on selected quality parameters or economic parameters based on their peer adjusted profiles.

C.   Bonuses are never paid by managed care organizations.

D.   Capitation amounts are based on the number of employees working at the managed care organization and bonuses are based on the number of human resource employees at the managed care organization. 

E.   None of the above.

8.   From a provider's perspective, why would the named parties to a managed care contract that the provider is considering entering into be important to know?  (Reference Class 7, "Basics" - "Basic Contract Structure")

Question 8 choices:

A B C D E 

A.   From a provider's perspective, the named parties are important to know so that the provider knows who their patients are.

B.   From a provider's perspective, the named parties are not important to know

C.   From a provider's perspective, the named parties are important to know because they identify how much income the provider will earn.

D.   From a provider's perspective - the named parties are important to know, because they may identify if the Managed Care Organization ("MCO") is a separate entity from the payer for services and if they are separate whether both are directly contractually obligated to or have privity with the provider.

E.  None of the above.

9.   How are providers impacted by termination provisions in managed care contracts that include post contractual obligations?  (Reference Class 7, "Term & Termination" - "Term and Termination Provisions")

Question 9 choices:

A B C D E  

A.   Managed care contracts with providers may include termination provisions that include post contractual obligations.

B.   Termination provisions that include post contractual obligations may require the provider to continue providing care to covered managed care members at the specified contract rate for an indefinite period following termination or expiration of contract.

C.   Providers usually seek to limit post-termination services to a fixed length of period (example: 60 - 90 days). 

D.   Providers usually seek to limit post-termination services to a fixed length of period and demand usual and customary charges if required to provide services beyond the initial period.

E.   All of the above.

10.   According to the readings for this class, what are some examples of provisions that some managed care companies may portray as "boilerplate", meaning the provisions are presented as standard or non-negotiable, that providers should look closely at?   (Reference Class 7, "Boilerplate" - "Miscellaneous Provisions")

Question 10 choices:

A B C D E  

1.    Indemnification and malpractice insurance requests.

2.    Dispute resolution procedures (example: mediation or arbitration).

3.    Ongoing disclosure or report obligations (example: provider’s licensing or accreditation survey reports are to be provided to Managed Care Organization).

4.    Non-competition, non-solicitation, geographic exclusivity covenants.

A.   1 and 2

B.   2 and 3

C.   3 and 4

D.   1, 2, 3, and 4

E.   None of the above.

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