M7: Quizzes Flashcards
The best analytics solutions include a(n) ________ tool - one that is both affordable and extensible if licensed for the entire organization.
A. ELT
B. Utilization Metrics
C. Visualization layer
D. Metadata
C. Visualization layer
Text, page 264
A macro trend that may affect day-to-day operations of HR teams is _________.
A. budgets that are not under stress
B. no workforce shifts
C. rising healthcare costs
D. not enough representatives
C. rising health care costs
Text, page 268
There are four types of analytics; one of them is described as recommended actions. That type of analytics is ______.
A. Descriptive
B. Predictive
C. Prescriptive
D. Diagnostic
C. Prescriptive
Text, page 269
______ tools that leverage health claims data from the previous year can allow employees to predict out-of-pocket costs for each health plan choice available.
A. Predictive analytics
B. Decision-support
C. Customized
D. Random
B. Decision-support
Text, page 271
_____ is the data collected and stored in desktop spreadsheets and databases and that is not being collected and managed in primary source systems, especially electronic medical records (EMRs).
A. Black space data
B. Green space data
C. White space data
D. Yellow space data
C. White space data
Text, page 263
Personalized Medicine and Prescriptive Analytics is Level _____ of the Healthcare Analytics Adoptions Model.
A. 4
B. 2
C. 8
D. 7
C. 8
Text, page 266
Between 2019 and 2020, there were three key analytical trends. One of them addressed mental health payments. During that time, there was a ______ increase in mental health plan payments year over year.
A. 10%
B. 15%
C. 5%
D. 20%
D. 20%
Text, page 269
HDHP participation is up _____ since 2018.
A. 10%
B. 18%
C. 30%
D. 25%
C. 30%
Text, Page 270
In the data world, there are four types of analytics. The type that answers the core question of “why it happened” is known as _____.
A. Descriptive
B. Predictive
C. Diagnostic
D. Prescriptive
C. Diagnostic
Text Page 269
Since 2014, prescription drug prices have increased by ______.
A. 33%
B. 36%
C. 28%
D. 39%
A. 33%
Text page 272
______ is a statistical technique commonly used to forecast future behavior.
A. Predictive modeling
B. Analytical modeling
C. Statistical modeling
D. Regression modeling
A. Predictive modeling
Study guide, page 6, learning outcome 1.2 and reading A, page 24
_______ is the process of inspecting, cleaning,
transforming, interpreting, and modeling data to
discover trends, patterns, and other information that
can support benefit plan decisions and changes.
A. Predictive analytics
B. Data analytics
C. Statistical analytics
D. Regression analytics
B. Data analytics
Study guide, page 6, Learning outcome 1.1 and Reading A, page 24
Health plans that offer opportunities to lower costs and increase flexibility in plan design are known as plans.
A. partially self-funded
B. self-funded
C. fully insured
D. fully funded
B. self-funded
Study guide, page 17, Learning Outcome 4.1 and Reading B, Page 29
Most audits find that approximately ______ percent of the total amount spent on claims annually is potentially overpaid or incorrectly paid.
A. 4 to 5
B. 9 to 10
C. 1 to 3
D. 6 to 8
C. 1 to 3
Study Guide, page 18, learning outcome 4.5 and Reading B, page 31
Total costs for audits normally ranges from $25,000 to ______ dollars.
A. $30,000
B. $40,000
C. $35,000
D. $50,000
D. $50,000
Study guide, page 21, learning Outcome 4.12 and Reading B, Page 33
Enterprise Data Warehouse is contained in Level _______ of the Healthcare Analytics Adoption Model.
A. 7
B. 5
C. 1
D. 3
C. 1
Study Guide, Page 16, Learning Outcome 3.3; text, page 266
There are ____ levels in the Healthcare Analytics Adoption Model.
A.6
B. 7
C. 8
D. 10
C. 8
Study Guide, Page 16, Learning Outcome 3.3; Text, page 266
All of the following are true regarding the macro trends impacting HR department operations today, EXCEPT:
A. Rising healthcare costs
B. Budgets under stress
C. Non-certified HR personnel
D. Workforce shifts
C. Non-certified HR personnel
Study Guide, Page 9, Learning Outcome 2.1; Text page 268
The four types of analytics and the core questions they answer include all of the following, EXCEPT:
A. Descriptive
B. Non-diagnostic
C. Predictive
D. Prescriptive
B. Non-diagnostic
Study Guide, page 10, learning outcome 2.2; text page 269
A robust ____ process-how analytics technology extracts data from source systems, applies the required transformations, and writes data into the target database-is fundamental to the success of the
chosen solution.
A. ATL
B. ETL
C. LTE
D. LTA
B. ETL
Study guide, page 15, learning outcome 3.2(g); text, pages 262-265
The best analytics solutions include a bundled visualization tool.
A. True
B. False
A. True
There are seven levels in the Healthcare Analytics Adoption Model.
A. True
B. False
B. False
There are 8 levels
Level 7 of the Healthcare Adoption Model is Clinical Risk Intervention and Predictive Analytics.
A. True
B. False
A. True
Predictive modeling is the process of inspecting, cleaning, transforming, interpreting, and modeling data to discover trends, patterns, and other information that can support benefit plan decisions and changes.
A. True
B. False
B. False
That is the definition for data analytics
Administrative claims audits retrospectively look at claims the carrier or TPA has paid in order to identify possible processing errors, overpayments, and underpayments.
A. True
B. False
A. True
Level 4 of the Healthcare Analytics Adoption Model is Automated Internal Reporting.
A. True
B. False
B. False
Automated EXTERNAL Reporting
Internal reporting is level 3
In a self-funded arrangement, the plan sponsor assumes the liability and risk associated with uncertain health care costs.
A. True
B. False
A. True
Most administrative claim audits find that 10% of the total amount spent on claims annually is potentially overpaid or incorrectly paid.
A. True
B. False
B. False
1-3%
Reinsurance audits ensure a plan has been set up appropriately in an administrator’s systems when a plan is moving to a new carrier, from fully insured to self-insured, or to significantly different benefit designs.
A. True
B. False
B. False
An audit should be conducted every three to four years for most plan sponsors if they keep the same carrier/administrator.
A. True
B. False
A. True
The process of inspecting, cleaning, transforming, interpreting, & modeling data to discover trends, patterns, & other information to support benefit plan decisions/changes is:
A. Predictive modeling
B. Health management strategy
C. Data analytics
D. Metadata repository
Answer: C Data analytics
Study Guide, Module 7, Page 6, Learning Outcome 1.1
Study Guide, Module 7, Reading A, Using Data to Improve Health Plan Performance and Participant Health, Page 24
Other types of audits that may be performed in conjunction with a primary claims audit include all of the following, EXCEPT:
A. Reinsurance audits
B. Claims payment audits
C. Operational audits
D. Transitional audits
Answer: B Claims payment audits
Study Guide, Module 7, Page 20, Learning Outcome 4.10
Study Guide, Module 7, Reading B, Trust But Verify—Claims Audits, Page 33
