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 # 41

The following statements apply to health reimbursement arrangements. Select the answer choice that contains the correct statement.

Only employers are permitted to establish and fund HRAs.

The popularity of HRAs waned following a 2002 ruling by U.S. Treasury Department regarding their treatment in the tax code.

HRAs must be offered in conjunction with a high-deductible health plan.

The guaranteed portability feature of HRAs has contributed to their popularity.

Question # 42

Some states mandate that an independent enrollment broker or benefits counselor contractor selected by the state must manage enrollment of the eligible Medicaid population into managed care. In other states a health plan can engage independent brokers and

Many states have regulations that prohibit health plans from using door-to-door and/or telephone solicitation to market health plan products to the Medicaid population.

Health plans are never allowed to medically underwrite individual market customers who are under age 65.

To promote a health plan product to the individual market, health plans typically use captive agents who give sales presentations to potential customers, rather than using promotion tools such as direct mail, telemarketing, or advertising.

Health plans typically are allowed to medically underwrite all individual market customers who are covered by Medicare and can refuse to cover such customers.

Question # 43

One feature of the Employee Retirement Income Security Act (ERISA) is that it:

Requires self-funded employee benefit plans to pay premium taxes at the state level.

Contains a pre-emption provision, which typically makes the terms of ERISA take precedence over any state laws that regulate employee welfare benefit plans.

Contains strict reporting and disclosure requirements for all employee benefit plans except health plans.

Requires that state insurance laws apply to all employee benefit plans except insured plans.

Question # 44

The Advantage Health Plan recently added the following features to its member services program:

1. IVR

2. Active member outreach program

3. Advantage's member services staffing needs are likely to increase as a result of

1 & 2

Neither 1 nor 2

Question # 45

The Ark Health Plan, is currently recruiting providers in preparation for its expansion into a new service area. A recruiter for Ark has been meeting with Dr. Nan Shea, a pediatrician who practices in Ark's new service area, in order to convince her to be

Credentialing

Accreditation

A sentinel event

A screening program

Question # 46

Most contracts between health plans and providers contain a provision which forbids providers from seeking compensation from patients if the health plan fails to compensate the provider because of insolvency or for any other reason. Such a provision is kn

due process provision

cure provision

hold-harmless provision

risk-sharing provision

Question # 47

One true statement about community rating, a rating method commonly used by health plans, is that:

It requires a health plan to set premiums for financing medical care according to the health plan's expected cost of providing medical benefits to a sub-group within the community.

A health plan usually uses community rating to set premiums for large groups.

It tends to lead to greater fluctuations in premium rates than do other rating methods.

A health plan seldom uses community rating to set premiums for large groups.

Question # 48

The contract between the Honolulu MCO and Beverley Hills Hospital contains a 90 day cure provision. The Beverley Hills Hospital breached one of the contract requirements on July 31, 2004. The hospital remedied the problem by October 31, 2004. Which of the

The contract would not be terminated as Beverley Hills hospital rectified the problem within 90 days.

The contract would be terminated as Beverley Hills hospital was required to notify Honolulu MCO about the problem at least 90 days in advance.

The contract would be terminated as Beverley Hills hospital was required to rectify the problem within 90 days.

The contract would not be terminated as Beverley Hills hospital may escape adherence to the cure provision.

Question # 49

The Citywide Health Group is a large provider-based health plan that includes physician groups, hospitals, and other facilities. In order to oversee and manage the operation of the organization, Citywide has established an enterprise scheduling system. The

provide information to Citywide's management regarding provider licensure, certification, and malpractice history

detect instances of overutilization, underutilization, or inappropriate utilization of medical resources

allow Citywide's different components to function as a single organization in arranging access to facilities and resources

facilitate the processing of requests for authorization of payment of benefits

Question # 50

The Blaine Healthcare Corporation seeks to manage its quality by first identifying the best practices and best outcomes for a given procedure. Blaine can then determine areas in which it can emulate the best practices in order to equal or surpass the best

provider profiling

benchmarking

peer review

quality assessment