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

Healthcare Management: An Introduction

Last Update 19 hours ago Total Questions : 367

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Question # 4

Which of the following is(are) CORRECT?

(A) Staff model HMOs can achieve maximum economies of scale but are heavily capital intensive.

(B) Staff model HMOs are closed panel.

A & B

None of the listed options

B & C

All of the listed options

Question # 5

The paragraph below contains two pairs of terms enclosed in parentheses. Determine which term in each pair correctly completes the paragraph. Then select the answer choice containing the two terms you have selected.

The Harbor Health Plan convened a litigation

a standing / ongoing

a standing / specific

an ad hoc / ongoing

an ad hoc / specific

Question # 6

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

Question # 7

Which of the following is CORRECT?

Electronic transmittal of authorization is subject to the same regulatory requirements as other methods of transmittal

Telephone transmittal increases data entry errors.

Medical review is conducted before administrative review.

Prospective review, concurrent review and retrospective review are types of utilization review

Question # 8

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 # 9

A differences between managed indemnity & traditional indemnity

Include precertification and utilization review techniques

Both are the same

Include network and quality review techniques

A & B

Question # 10

The following statements are about preferred provider organizations (PPOs). Select the answer choice that contains the correct statement.

PPOs generally assume full financial risk for arranging medical services for their members.

PPOs generally pay a larger portion of a member's medical expenses when that member uses in-network providers than when the member uses out-of-network providers.

PPO networks may include primary care physicians and hospitals, but generally do not include specialists.

In a PPO, the most common method used to reimburse physicians is capitation.