AHM-250 AHIP Healthcare Management: An Introduction exact Exam Questions

Healthcare Management: An Introduction

Last Update 4 hours ago Total Questions : 367

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Question # 31

The following statement(s) can correctly be made about electronic data interchange (EDI):

EDI differs from eCommerce in that EDI involves back-and-forth exchanges of information concerning individual transactions, whereas eCommerce is the transfer of d

Both A and B

A only

B only

Neither A nor B

Question # 32

In order to generate exchanges with consumers, healthcare plan marketers use the four elements of the marketing mix: product, price, place (distribution), and

segmentation

publicity

promotion

plan design

Question # 33

The following statement(s) can correctly be made about the Joint Commission on Accreditation of Healthcare Organizations (JCAHO):

JCAHO's accreditation process for MCOs and healthcare networks consists of complete on-site surveys conducted every three

A only

Neither A nor B

Both A and B

B only

Question # 34

The following statements describe healthcare services delivered to health plan members by plan providers. Select the statement that describes a service that would most likely require utilization review and authorization.

Adele Farnsworth visited a dermatologist to have a mole removed from her arm.

Jonathan Lang underwent an electrocardiogram (EKG) during an office visit with his cardiologist.

Corinne Maxwell underwent physical therapy after being hospitalized for hip replacement surgery.

Jose Redriguez, a 70-year-old Medicare patient, received a flu shot as part of his annual physical examination.

Question # 35

To set up and contribute to an HSA, an individual must:

Be covered by a high-deductible health plan that meets federal requirements.

Not have other health insurance.

Not be enrolled in Medicare.

All of the above.

Question # 36

Patrick Flaherty's employer has contracted to receive healthcare for its employees from the Abundant Healthcare System. Mr. Flaherty visits his primary care physician (PCP), who sends him to have some blood tests. The PCP then refers Mr. Flaherty to a special

an integrated delivery system (IDS)

a Management Services Organization (MSO)

a Physician Practice Management (PPM) company

a physician-hospital organization (PHO)

Question # 37

Which is an advantage of a for-profit health plan?

Flexibility in raising capital

Double taxation

Exemption from paying federal income taxes.

None of the above.

Question # 38

When determining the premium rates it will charge a particular group, the Blue Jay Health Plan used a rating method known as community rating by class (CRC). Under this rating method, Blue Jay

was allowed to use no more than four rating classes when determining how much to charge the group for health coverage

was required to make the average premium in each class no more than 105% of the average premium for any other class

divided its members into rating classes based on demographic factors, experience, or industry characteristics, and then charged each member in a rating class the same premium

charged all employers or other group sponsors the same dollar amount for a given level of medical benefits, without adjustments for age, gender, industry, or experience