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 # 71

Greentree Medical, a health plan, is currently recruiting PCPs in preparation for its expansion into a new service area. Abigail Davis, a recruiter for Greentree, has been meeting with Melissa Cortelyou, M.D., in an effort to recruit her as a PCP in Green

Greentree is prevented by law from offering a contract to Dr. Cortelyou until the credentialing process is complete

any contract signed by Dr. Cortelyou should include a clause requiring the successful completion of the credentialing process within a defined time frame in order for the contract to be effective

Greentree must offer a standard contract to Dr. Cortelyou, without regard to the outcome of the credentialing process

Greentree will abandon the credentialing process now that Dr. Cortelyou has agreed to participate in Greentree's network

Question # 72

As part of its utilization management (UM) system, the Creole Health Plan uses a process known as case management. The following individuals are members of the Creole Health Plan:

Jill Novacek, who has a chronic respiratory condition.

Abraham Rashad.

Ms. Novacek, Mr. Rashad, and Mr. Devereaux

Ms. Novacek and Mr. Rashad only

Ms. Novacek and Mr. Devereaux only

None of these members

Question # 73

Al Marak, a member of the Frazier Health Plan, has asked for a typical Level One appeal of a decision that Frazier made regarding Mr. Marak's coverage. One true statement about this Level One appeal is that

Mr. Marak has the right to appeal to the next level if the Level One appeal upholds the original decision

It requires Frazier and Mr. Marak to submit to arbitration in order to resolve the dispute

It is considered to be an informal appeal

It will be handled by an independent review organization (IRO)

Question # 74

Historically most HMOs have been

Closed-access HMO

Closed-panel HMO

Open-access HMO

Open-panel HMO

Question # 75

During the risk assessment process for a traditional indemnity group insurance health plan, group underwriters consider such characteristics as a group’s geographic location, the size and gender mix of the group, and the level of participation in the grou

Healthcare costs are typically higher in rural areas than in large urban areas.

The morbidity rate for males is higher than the morbidity rate for females.

The larger the group, the more likely it is that the group will experience losses similar to the average rate of loss that was predicted.

All of the above

Question # 76

A common physician-only integrated model is a group practice without walls (GPWW). One characteristic of a typical GPWW is that the

GPWW combines multiple independent physician practices under one umbrella organization

GPWW generally has a lesser degree of integration than does an IPA

member physicians cannot own the GPWW

GPWW's member physicians must perform their own business operations

Question # 77

Health plans' use of the Internet to provide plan members with health-related information has grown rapidly in recent years. One advantage the Internet has over other forms of communication is that

users can access the Internet using a number of different types of computer systems

access to the Internet is available only to members of the health plan's network

the Internet is immune to internal security breaches by employees or trading partners within the network

users can contact a single controlling organization to rectify disruptions in Internet service

Question # 78

All CDHP products provide federal tax advantages while allowing consumers to save money for their healthcare.

True

False

Question # 79

Col. Martin Avery, on active duty in the U.S. Army, is eligible to receive healthcare benefits under one of the three TRICARE health plan options. If Col Avery elects to participate in TRICARE Prime, he will be

able to obtain full benefits for services obtained from network and non-network providers

subject to copayment, deductible, and coinsurance requirements for any medical care he receives

required to formally enroll for coverage and pay an enrollment fee

assigned to a primary care manager who is responsible for coordinating all his care

Question # 80

One way that MCOs involve providers in risk sharing is by retaining a percentage of the providers' payment during a plan year. At the end of the plan year, the MCO may use the amount retained to offset or pay for any cost overruns for referral or hospital

withholds

usual, customary, and reasonable (UCR) fees

risk pools

per diems