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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 # 61

If a state commissioner of insurance places an HMO under administrative supervision, then the purpose of this action most likely is to:

A.

Transfer all of the HMO's business to other carriers.

B.

Allow the state commissioner, acting for a state court, to take control of and administer the HMO's assets and liabilities.

C.

Sell the HMO's assets in order to satisfy the HMO's obligations.

D.

Place the HMO's operations under the direction and control of the state commissioner or a person appointed by the commissioner.

Question # 62

During an open enrollment period in 1997, Amy Hadek enrolled through her employer for group health coverage with the Owl Health Plan, a federally qualified HMO. At the time of her enrollment, Ms. Hadek had three pre-existing medical conditions: angina, fo

A.

the angina, the high blood pressure, and the broken ankle

B.

the angina and the high blood pressure only

C.

none of these conditions

D.

the broken ankle only

Question # 63

According to the IRS, which of the following is not an allowable preventive care service?

A.

Smoking cessation programs.

B.

Periodic health examinations.

C.

Health club memberships.

D.

Immunizations for children and adults.

Question # 64

Health plans require utilization review for all services administered by its participating physicians.

A.

True

B.

False

Question # 65

The NAIC adopted the HMO Model Act in order to provide a system of ongoing regulatory monitoring of HMOs. All of the following statements are correct about the HMO Model Act EXCEPT that it:

A.

Regulates HMO operations in two critical areas: financial responsibility and healthcare delivery.

B.

Requires each HMO to send state regulators an annual report describing the HMO's finances and operations.

C.

Focuses on three key aspects of healthcare delivery: network adequacy, quality assurance, and grievance procedures.

D.

Requires state insurance departments to conduct annual examinations of an HMO's operations, quality assurance programs, and provider networks.

Question # 66

Health plans may use different capitation arrangements for different levels of service. One typical capitation arrangement provides a capitation payment that may include primary care only, or both primary and secondary care, but not ancillary services. The

A.

global capitation arrangement

B.

gatekeeper arrangement

C.

carve-out arrangement

D.

partial capitation arrangement

Question # 67

As part of its quality management program, the Lyric Health Plan regularly compares its practices and services with those of its most successful competitor. When Lyric concludes that its competitor's practices or services are better than its own, Lyric im

A.

Benchmarking.

B.

Standard of care.

C.

An adverse event.

D.

Case-mix adjustment.

Question # 68

The following statements describe two types, or models, of HMOs:

The Quest HMO has contracted with only one multi-specialty group of physicians. These physicians are employees of the group practice, have an equity interest in the practice, and provide

A.

A captive group a staff model

B.

A captive group a network model

C.

An independent group a network model

D.

An independent group a staff model

Question # 69

Health plans can organize under a not-for-profit form or a for-profit form. One true statement regarding not-for-profit health plans is that these organizations typically

A.

are exempt from review by the Internal Revenue Service (IRS)

B.

are organized as stock companies for greater flexibility in raising capital

C.

rely on income from operations for the large cash outlays needed to fund long-term projects and expansion

D.

engage in lobbying or political activities in order to maintain their tax-exempt status

Question # 70

In order to cover some of the gap between FFS Medicare coverage and the actual cost of services, beneficiaries often rely on Medicare supplements. Which of the following statements about Medicare supplements is correct?

A.

The initial ten (A-J) Medigap policies offer a basic benefit package that includes coverage for Medicare Part A and Medicare Part B coinsurance.

B.

Each insurance company selling Medigap must sell all the different Medigap policies.

C.

Medicare SELECT is a Medicare supplement that uses a preferred provider organization (PPO) to supplement Medicare Part A coverage.

D.

Medigap benefits vary by plan type (A through L), and are not uniform nationally.

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