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AHIP AHM-250 - Healthcare Management: An Introduction

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Total 367 questions

When the Knoll Company purchased group health coverage from the Castle Health Maintenance Organization (HMO), the agreement between the two parties specified that the plan would be a typical fully funded plan. Because Knoll had been covered under a previo

A.

Castle is responsible for paying for all incurred covered benefits

B.

Knoll is solely responsible for guaranteeing claim payments

C.

Knoll makes no premium payments to Castle

D.

Castle has no responsibilities for administering the health plan

The following statements are about the make-up and function of an HMO's board of directors.

Select the answer choice that contains the correct statement.

A.

The make-up of an HMO's board of directors is prescribed by state regulations and does not vary according to whether the plan is a for-profit or not-for-profit plan.

B.

The board of directors of a not-for-profit HMO is exempt from liability for its actions.

C.

An HMO's board of directors is not responsible for supervising the performance of its officers and outside advisors.

D.

A primary function of the board of directors is to approve and evaluate the organization's operational policies and procedures.

The existing committees at the Majestic Health Plan, a health plan that is subject to the requirements of HIPAA, include the Executive Committee and the Corporate Compliance Committee. The Executive Committee serves as a long-term advisory body on issues related to overall organizational policy. The Corporate Compliance Committee are convened to address specific management concerns. The following statement(s) can correctly be made about these committees:

A.

Majestic's Executive Committee is an example of a Specific committee.

B.

The Corporate Compliance Committee is an Example of an Adhoc company.

C.

A & B

Which facility would best meet the need of Jack who fell on road and sprained his ankle?

A.

Emergency Department

B.

Urgent Care Centre

C.

Home health care

D.

None of the above

To address the problems associated with multiple data management systems, the Kayak Health Plan has begun to use a data warehouse. One likely characteristic of Kayak's data warehouse is that:

A.

It requires Kayak's individual databases to store large amounts of data that are not needed for daily operations.

B.

It contains data from internal sources only.

C.

It stores historical data rather than current data.

D.

The data in the warehouse are linked by a common subject.

The following statement(s) can correctly be made about Medicaid managed care plans:

A.

A state may mandate health plan enrollment if it offers enrollees in non-rural areas a choice of at least two health plans and offers rural enrollees a choice of at lea

B.

Both A and B

C.

A only

D.

B only

E.

Neither A nor B

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

A.

was allowed to use no more than four rating classes when determining how much to charge the group for health coverage

B.

was required to make the average premium in each class no more than 105% of the average premium for any other class

C.

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

D.

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

The Hill Health Plan designed a set of benefits that it packaged in the form of a PPO product. Hill then established a pricing structure that allowed its product to compete in the small group market, and it developed advertising designed to inform potential

A.

$140

B.

$170

C.

$180

D.

$210

The following statements are about health information networks (HINs). Three of the statements are true and one statement is false. Select the answer choice containing the FALSE statement.

A.

Most HINs are built on proprietary computer networks rather than being Internet based.

B.

While a HIN is for the exclusive use of one organization, a community health information network (CHIN) is shared by several organizations.

C.

A health plan can use a secured extranet design or a distributed database approach for its HIN.

D.

HINs have the potential to increase the quality of medical care because they make a patient's medical history readily available to each provider at the point of service.

The following types of CDHPs allow federal tax advantages including the ability to roll funds from one year to the next:

A.

MSAs, HRAs, HSAs

B.

FSAs, MRAs, HRAs

C.

FSAs, HRAs, HSAs

D.

FSAs, MRAs HSAs