M7: Quizzes

Question 1

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

Answer 1

C. Visualization layer

Text, page 264

Question 2

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

Answer 2

C. rising health care costs

Text, page 268

Question 3

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

Answer 3

C. Prescriptive

Text, page 269

Question 4

______ 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

Answer 4

B. Decision-support

Text, page 271

Question 5

_____ 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

Answer 5

C. White space data

Text, page 263

Question 6

Personalized Medicine and Prescriptive Analytics is Level _____ of the Healthcare Analytics Adoptions Model.

A. 4
B. 2
C. 8
D. 7

Answer 6

C. 8

Text, page 266

Question 7

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%

Answer 7

D. 20%

Text, page 269

Question 8

HDHP participation is up _____ since 2018.

A. 10%
B. 18%
C. 30%
D. 25%

Answer 8

C. 30%

Text, Page 270

Question 9

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

Answer 9

C. Diagnostic

Text Page 269

Question 10

Since 2014, prescription drug prices have increased by ______.

A. 33%
B. 36%
C. 28%
D. 39%

Answer 10

A. 33%

Text page 272

Question 11

______ is a statistical technique commonly used to forecast future behavior.

A. Predictive modeling
B. Analytical modeling
C. Statistical modeling
D. Regression modeling

Answer 11

A. Predictive modeling

Study guide, page 6, learning outcome 1.2 and reading A, page 24

Question 12

_______ 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

Answer 12

B. Data analytics

Study guide, page 6, Learning outcome 1.1 and Reading A, page 24

Question 13

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

Answer 13

B. self-funded

Study guide, page 17, Learning Outcome 4.1 and Reading B, Page 29

Question 14

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

Answer 14

C. 1 to 3

Study Guide, page 18, learning outcome 4.5 and Reading B, page 31

Question 15

Total costs for audits normally ranges from $25,000 to ______ dollars.

A. $30,000
B. $40,000
C. $35,000
D. $50,000

Answer 15

D. $50,000

Study guide, page 21, learning Outcome 4.12 and Reading B, Page 33

Question 16

Enterprise Data Warehouse is contained in Level _______ of the Healthcare Analytics Adoption Model.

A. 7
B. 5
C. 1
D. 3

Answer 16

C. 1

Study Guide, Page 16, Learning Outcome 3.3; text, page 266

Question 17

There are ____ levels in the Healthcare Analytics Adoption Model.

A.6
B. 7
C. 8
D. 10

Answer 17

C. 8

Study Guide, Page 16, Learning Outcome 3.3; Text, page 266

Question 18

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

Answer 18

C. Non-certified HR personnel

Study Guide, Page 9, Learning Outcome 2.1; Text page 268

Question 19

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

Answer 19

B. Non-diagnostic

Study Guide, page 10, learning outcome 2.2; text page 269

Question 20

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

Answer 20

B. ETL

Study guide, page 15, learning outcome 3.2(g); text, pages 262-265

Question 21

The best analytics solutions include a bundled visualization tool.

A. True
B. False

Answer 21

A. True

Question 22

There are seven levels in the Healthcare Analytics Adoption Model.

A. True
B. False

Answer 22

B. False

There are 8 levels

Question 23

Level 7 of the Healthcare Adoption Model is Clinical Risk Intervention and Predictive Analytics.

A. True
B. False

Answer 23

A. True

Question 24

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

Answer 24

B. False

That is the definition for data analytics

Question 25

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

Answer 25

A. True

Question 26

Level 4 of the Healthcare Analytics Adoption Model is Automated Internal Reporting.

A. True
B. False

Answer 26

B. False

Automated EXTERNAL Reporting
Internal reporting is level 3

Question 27

In a self-funded arrangement, the plan sponsor assumes the liability and risk associated with uncertain health care costs.

A. True
B. False

Answer 27

A. True

Question 28

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

Answer 28

B. False

1-3%

Question 29

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

Answer 29

B. False

Question 30

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

Answer 30

A. True

Question 31

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 31

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

Question 32

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 32

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