AHIP Healthcare Management: An Introduction - AHM-250 Exam Practice Test
The act which requires each group health plan to allow employees and certain dependents to continue their group coverage for a stated period of time following a qualifying event that causes the loss of group health coverage is:
Correct Answer: A
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Prescription drug benefits in Medicare can be obtained through:
Correct Answer: C
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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.
(C)
Staff model HMOs operate out of ambulatory care facilities.
(A)
Staff model HMOs can achieve maximum economies of scale but are heavily capital intensive.
(B)
Staff model HMOs are closed panel.
(C)
Staff model HMOs operate out of ambulatory care facilities.
Correct Answer: C
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In order to compensate for lost revenue resulting from services provided free or at a significantly reduced cost to other patients, many healthcare providers spread these unreimbursed costs to paying patients or third-party payors. This practice is known
Correct Answer: A
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The National Association of Insurance Commissioners' (NAIC's) Unfair Claims Settlement
Practices Act specifies standards for the investigation and handling of claims. The Act defines unfair claims practices and notes that such practices are improper if the
Practices Act specifies standards for the investigation and handling of claims. The Act defines unfair claims practices and notes that such practices are improper if the
Correct Answer: A
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In certain situations, a health plan can use the results of utilization review to intervene, if necessary, to alter the course of a plan member's medical care. Such intervention can be based on the results of
Correct Answer: C
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Which facility would best meet the need of Jack who fell on road and sprained his ankle?
Correct Answer: C
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The following statements are about the non-group market for managed care products in the United States. Select the answer choice containing the correct statement.
Correct Answer: A
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What is a mathematical process that involves using a number of hypothetical situations that, in total, will reasonably reflect an event that will occur in real life
Correct Answer: B
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In preparation for its expansion into a new service area, the Regal MCO is meeting with Dr. Nancy Buhner, a cardiologist who practices in Regal's new service area, in order to convince her to become one of the plan's participating providers. As part of the
Correct Answer: A
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Who will be covered by TRICARE PRIME by applying for enrollment
Correct Answer: B
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One true statement regarding ethics and laws is that the values of a community are reflected in
Correct Answer: B
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Bill Clinton is a member of Lewinsky's PBM plan which has a three-tier copayment structure. Bill fell ill and his doctor prescribed him AAA, a brand-name drug which was included in the Lewinsky's formulary; BBB, a non-formulary drug; and CCC, a generic dr
Correct Answer: C
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The following programs are part of the Alcove MCO's utilization management (UM) program:
A telephone triage program
Preventive care initiatives
A shared decision-making program
A self-care program
With regard to the UM programs, it is most likely cor
The following programs are part of the Alcove MCO's utilization management (UM) program:
A telephone triage program
Preventive care initiatives
A shared decision-making program
A self-care program
With regard to the UM programs, it is most likely cor
Correct Answer: D
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