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Healthcare Management: An Introduction

Last Update 4 hours ago Total Questions : 367

The Healthcare Management: An Introduction content is now fully updated, with all current exam questions added 4 hours ago. Deciding to include AHM-250 practice exam questions in your study plan goes far beyond basic test preparation.

You'll find that our AHM-250 exam questions frequently feature detailed scenarios and practical problem-solving exercises that directly mirror industry challenges. Engaging with these AHM-250 sample sets allows you to effectively manage your time and pace yourself, giving you the ability to finish any Healthcare Management: An Introduction practice test comfortably within the allotted time.

Question # 51

One true statement regarding ethics and laws is that the values of a community are reflected in

A.

both ethics and laws, and both ethics and laws are enforceable in the court system

B.

both ethics and laws, but only laws are enforceable in the court system

C.

ethics only, but only laws are enforceable in the court system

D.

laws only, but both ethics and laws are enforceable in the court system

Question # 52

The Cleopatra Group, a third-party administrator (TPA), has entered into a TPA agreement with the Alexander MCO with regard to the administration of a particular health plan. This agreement complies with all of the provisions of the NAIC TPA Model Law. On

A.

hold all funds it receives on behalf of Alexander in trust

B.

assume full responsibility for determining the claim payment procedures for the plan

C.

assume full responsibility for ensuring that the health plan is administered properly

D.

obtain from the federal government a certificate of authority designating the Cleopatra Group as a TPA

Question # 53

One of the most influential pieces of legislation in the advancement of managed care within the United States was the HMO Act of 1973. One provision of the HMO Act of 1973 was that it

A.

emphasized compensating physicians based solely on the volume of medical services they provide

B.

exempted HMOs from all state licensure requirements

C.

established a process under which HMOs could elect to be federally qualified

D.

required federally qualified HMOs to relate premium levels to the health status of the individual enrollee or employer group

Question # 54

Many HMOs are compensated for the delivery of healthcare to members under a prepaid care arrangement. Under a prepaid care arrangement, a plan member typically pays a

A.

fixed amount in advance for each medical service the member receives

B.

a small fee such as $10 or $15 that a member pays at the time of an office visit to a network provider

C.

a fixed, monthly premium paid in advance of the delivery of medical care that covers most healthcare services that a member might need, no matter how often the member uses medical services

D.

specified amount of the member's medical expenses before any benefits are paid by the HMO

Question # 55

The agreement by two or more independent competitors on the prices or fees that they will charge for services is known as:

A.

Tying arrangements

B.

Price fixing

C.

Horizontal group boycott

D.

Horizontal division of markets

Question # 56

The following statements are about standards set forth in the Quality Improvement System for Managed Care (QISMC), established by the Health Care Financing Administration (HCFA, now known as the Centers for Medicare and Medicaid Services).

A.

As a result of the Balanced Budget Refinement Act (BBRA), PPOs are required to meet all QISMC quality requirements.

B.

QISMC standards typically do not apply to such Medicare services as mental health or substance abuse services.

C.

Medicaid primary care case manager (PCCM) programs are subject to the same QISMC quality standards and performance measures as are all other Medicare and Medicaid programs.

D.

QISMC standards and guidelines are required for Medicare MCOs, but they are applicable to Medicaid MCOs at the discretion of the individual states.

Question # 57

The Hill Health Plan designed a set of benefits that it packaged in the form of a PPO product. Hill then established a pricing structure that allowed its product to compete in the small group market, and it developed advertising designed to inform potential

A.

A decision as to which exclusions or limitations would apply for this product.

B.

A decision as to how to establish the network of participating providers for this product

C.

A determination of the level at which this product would cover out-of-network services.

D.

All of the above.

Question # 58

The Venus Hospital provides medical care to paying patients, as well as to people who either have no healthcare coverage and cannot pay for the care by themselves or who receive services at reduced rates because they are covered under government sponsored

A.

anti selection

B.

cost shifting

C.

receivership

D.

underwriting

Question # 59

Appropriateness of treatment provided is determined by developing criteria that if unmet will prompt further investigation of a claim which are also called:

A.

Codes

B.

Lists

C.

Edits

D.

Checks

Question # 60

Allgood Medical, Inc., a health plan, has contracted with Mercy Memorial Hospital to provide inpatient medical services to Allgood's plan members. The terms of the contract specify that Allgood will reimburse Mercy Memorial on the basis of a negotiated ch

A.

per diem agreement

B.

fee-for-service agreement

C.

withhold agreement

D.

diagnostic related group (DRG) agreement

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