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AHIP AHM-250 - Healthcare Management: An Introduction

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Total 367 questions

The following statements describe violations of antitrust legislation:

Situation A - Two health plans in a single service area divided purchasers into two groups and agreed to each market their products to only one purchaser group.

Situation B - A spec

A.

Situation A - horizontal division of markets Situation B - tying arrangement.

B.

Situation A - horizontal division of markets Situation B - price fixing.

C.

Situation A - horizontal group boycott Situation B - tying arrangement.

D.

Situation A - horizontal group boycott Situation B - price fixing.

The following statements are about the accessibility of healthcare coverage and medical care in the United States. Select the answer choice that contains the correct statement.

A.

A person’s employment status as a full-time employee guarantees that person access to healthcare coverage.

B.

Most people who have healthcare coverage are covered under an individual insurance policy rather than a group insurance plan.

C.

The percentage of the population without healthcare coverage is evenly distributed throughout the United States.

D.

Hospital closings have occurred disproportionately in rural areas and inner cities and have reduced access to healthcare in these areas.

In the CPT system, each service or procedure is identified by

A.

Three-digit with decimal point

B.

Three-digit

C.

Five-digit with decimal point

D.

Five-digit

Which of the following population groups are eligible for Medicare coverage

A.

Individuals aged 65 & above, regardless of income & medical history

B.

Individuals suffering from end stage renal disease, regardless of age

C.

Individuals aged 50 or above suffering from qualifying disabilities

D.

Both A & B

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

A.

Forecasting

B.

Modelling

C.

Both a and b

D.

None of the above

The following statements apply to Archer medical savings accounts. Select the answer choice that contains the correct statement.

A.

MSAs were established as a demonstration project under the Medicare Modernization Act.

B.

MSAs were seen as an improvement over FSAs because they are portable, allowing employees to take the funds with them when they change jobs.

C.

The popularity of MSAs has been limited because funds may not be rolled over from year to year.

D.

MSAs are one of the fastest growing Types of Consumer-Directed Health Plans.

The health plan determines what it considers to be the acceptable fee for a service or procedure and the physician agrees to accept that amount as payment in full for the procedure

A.

Usual, Customary, and Reasonable fee

B.

Discounted FFS

C.

Fee Maximum

D.

Relative Value Scale

The statements below describe technology used by two MCOs to respond to incoming telephone calls:

    The Morton MCO uses an automated system that answers telephone calls with recorded or synthesized speech and prompts the caller to respond to a menu of opt

A.

Autumn's device is best described as an interactive voice response (IVR) system.

B.

Both Morton's system and Autumn's device are applications of computer/telephony integration (CTI).

C.

Morton's system is best described as an automatic call distributor (ACD).

D.

Morton's system can be correctly characterized as an expert system.

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.

A.

In order to promote a product to the individual market, MCOs typically rely on personal selling by captive agents rather than on promotional tools such as direct mail, telemarketing, and advertising.

B.

Managed Medicare plans typically are allowed to reject a Medicare applicant on the basis of the results of medical underwriting of the applicant.

C.

HCFA (now known as the Centers for Medicare and Medicaid Services) must approve all membership and enrollment materials used by MCOs to market managed care products to the Medicare population.

D.

Managed care plans are not allowed to health screen individual market customers who are under age 65, even if the health screen could help prevent anti selection.

The Titanium Health Plan and a third-party administrator (TPA) have entered into a TPA agreement with regard to the administration of a particular health plan. This agreement complies with all of the provisions of the NAIC TPA Model Law. One of the TPA's

A.

Hold all funds it receives on behalf of Titanium in trust.

B.

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

C.

Obtain from the federal government a certificate of authority designating the organization as a TPA.

D.

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