AHM-250 Online Practice Questions and Answers

A public employer, such as a municipality or county government would be considered which of the following?

A. Employer-employee group

B. Multiple-employer group

C. Affinity group

D. Debtor-creditor group

Employer-sponsored benefit plans that provide healthcare benefits must comply with the Employee Retirement Income Security Act (ERISA). One of the most significant features of ERISA is that it

A. contains a provision stating that the terms of ERISA generally take precedence over any state laws that regulate employee welfare benefit plans

B. standardizes the conversion of group healthcare benefits to individual healthcare benefits

C. mandates that self-funded healthcare plans must pay state premium taxes

D. requires that all active employees, regardless of age, must be eligible for coverage under employer-sponsored benefit plans

Arthur Moyer is covered under his employer's group health plan, which must comply with the Consolidated Omnibus Budget Reconciliation Act (COBRA). Mr. Moyer is terminating his employment. He has elected to continue his coverage under his employer's group

A. 18 months, but his coverage under COBRA will cease if he obtains group health coverage through another employer.

B. 18 months, even if he obtains group health coverage through another employer.

C. 36 months, but his coverage under COBRA will cease if he obtains group health coverage through another employer.

D. 36 months, even if he obtains group health coverage through another employer.

Before the Leo Health Maintenance Organization (HMO) received a certificate of authority (COA) to operate in State X, it had to meet the state's licensing requirements and financial standards which were established by legislation that is identical to the

A. receive compensation based on the volume and variety for medical services they perform for Leo plan members, whereas the specialists receive compensation based solely on the number of plan members who are covered for specific services

B. have no financial incentive to practice preventive care or to focus on improving the health of their plan members, whereas the specialists have a positive incentive to help their plan members stay healthy

C. receive from the IPA the same monthly compensation for each Leo plan member under the PCP's care, whereas the specialists receive compensation based on a percentage discount from their normal fees

D. receive compensation based on a fee schedule, whereas the specialists receive compensation based on per diem charges

The Acme HMO recruits and contracts directly with a wide range of physicians--both PCPs and specialists--in its geographic area on a non-exclusive basis. There is no separate legal entity that represents and negotiates the contracts for the physicians. The

A. an independent practice association (IPA) model HMO

B. a staff model HMO

C. a direct contract model HMO

D. a group model HMO

The Clover Group is a for-profit MCO that operates in the United States. The Valentine Group owns all of Clover's stock. The Valentine Group's sole business is the ownership of controlling interests in the shares of other companies. This information indic

A. holding company of the Valentine Group

B. sister corporation of the Valentine Group

C. parent company of the Valentine Group

D. subsidiary of the Valentine Group

The main purpose of the Health Plan Employer Data and Information Set (HEDIS) is to provide

A. expert consultation to end-users for solving specialized and complex healthcare problems through the use of a knowledge-based computer system

B. a comprehensive accreditation for PPOs

C. measurements of plan performance and effectiveness that potential healthcare purchasers can use to compare quality offered by different healthcare plans

D. a mathematical model that can predict future claim payments and premiums

George was covered by a united health care insurance policy. This policy says that Geroge has to pay $300 out of pocket for the medical expenses in that year before united health care will start to reimburse the medical expense incurred for George. What is the term used to call the out of pocket payment made by George.

A. Co-payment

B. Deductible

C. Coinsurance

D. None of the above

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

The Manor Health Plan uses an automated system that answers telephone calls with recorded or synthesized speech and prompts the caller to respond t

A. Manor's system is best described as an automated call distributor (ACD).

B. Both Manor's system and Squire's device are applications of computer/telephone integration (CTI).

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

D. All of these statements are correct.

Which of the following statements is true?

A. A declining economy can lead to lower healthcare costs as a result of an older population with greater healthcare needs.

B. A larger patient population increases pressure on the health plan to offer larger panels.

C. Provider networks are not affected by the federal and state laws that apply to health plans

D. Network management standards established by independent accrediting organizations have no influence on health plan network design.