Free AHM-250 Exam Dumps Preview

During the height of the recent cost upswing, insurance premiums were increasing by more than 13% annually.

Increased utilization was the largest factor contributing to the rise in premiums, accounting for 43% of the increase.

Employer payers began seeking ways to control spiraling utilization rates and provide lower cost health coverage options.

Co-payment

Coinsurance

None of the above

Coordinated care plans, medical savings accounts and national PPOs.

Private Fee for Service plans, health care prepayment plans and medical savings accounts

Cost contracts, coordinated care programs and medical savings accounts.

Anti selection

receivership

Underwriting

MBHOs generally provide benefits for mental health services but not for chemical dependency services.

The level of care needed to treat behavioral disorders is the same for all patients and all disorders.

PCP gatekeeper systems for behavioral healthcare generally result in more accurate diagnoses, more effective treatment, and more efficient use of resources than do centralized referral systems.

Lower

Same

No change

mandated certain requirements that all HMOs had to meet in order to conduct business

required that all HMOs be licensed as insurance companies

encouraged the use of pre-existing condition exclusion provisions in all HMO contracts

both ethics and laws, and both ethics and laws are enforceable in the court system

ethics only, but only laws are enforceable in the court system

laws only, but both ethics and laws are enforceable in the court system

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

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

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

Previously separate providers combine & come under common ownership or control.

Two or more providers combine their business operations that they previously carried out separately.

None of the above

a manual rating contract

a funding vehicle contract

a pooling contract

an amount based on the weighted value of each medical procedure or service that Isle provides, and

the weighted value is determined by the appropriate current procedural terminology (CPT) code for the procedure or service

a retrospective reimbursement based on the actual costs of the Oriole member's hospitalization

a specific negotiated amount for each day the Oriole member is hospitalized

B only

A and B

none of the above

a consolidation

a merger

an acquisition

Measure A clinical status Measure B patient perception

Measure A functional status Measure B patient perception

Measure A functional status Measure B clinical status

Accreditation is typically performed by a panel of physicians and administrators employed by the health plan under evaluation.

All accrediting organizations use the same standards of accreditation.

Results of accreditation evaluations are provided only to state regulatory agencies and are not made available to the general public.

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

a comprehensive accreditation for PPOs

a mathematical model that can predict future claim payments and premiums

365

920

500

Health Care Quality Improvement Program (HCQIP)

Health Plan Management System (HPMS)

Health Care Prepayment Plan (HCPP)

compensatory damages, which compensate the injured party for his or her injuries

punitive damages, which are designed to punish or make an example of the wrongdoer

all of the above

The GLB Act allows convergence among the transaction

Both A and B

B only

Neither A nor B

1.2 million

3.2 million

4.2 million

A & B

None of the listed options

B & C

Diagnosis-related group (DRG) system

Partial capitation arrangement

Capped fee system

Knoll is solely responsible for guaranteeing claim payments

Knoll makes no premium payments to Castle

Castle has no responsibilities for administering the health plan

Individuals enrolled in a MA plan must enroll in a stand-alone Part D prescription drug plan.

Individuals enrolled in a MA plan do not have to be eligible for Medicare Part A

Individuals can enroll in MA plan in multiple regions.

greater/lesser

lesser/greater

lesser/lesser

Employ, rather than contract with, participating physicians

Achieve economies of scale through facility consolidation and practice management

Refrain from the corporate practice of medicine

access to the Internet is available only to members of the health plan's network

the Internet is immune to internal security breaches by employees or trading partners within the network

users can contact a single controlling organization to rectify disruptions in Internet service

Knoll and all covered Knoll employees only

Castle, Knoll, and all covered Knoll employees

Castle and all covered Knoll employees only

Life Style of the people

Advancement in information technology

A, B, and C

B and C only

A and B only

focus on individual episodes of medical care rather than on the comprehensive care of the patient over time

are used to coordinate the care of members with any type of disease, either chronic or nonchronic

focus on managing populations of patients who have a specific chronic illness or medical condition, but do not focus on patient populations who are at risk of developing such an illness or condition

Health plans and their providers are obligated not to harm their members

Health plans and their providers should treat each member in a manner that respects the member's goals and values, and they also have a duty to promote the good of the members as a group

Health plans and their providers should allocate resources in a way that fairly distributes benefits and burdens among the members

$0

$300

$900

Does not provide any clinical decision support for Mosaic's providers.

Contains a Mosaic member's clinical data only.

Is organized by the type of treatment or by provider.

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

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

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

is a performance-measurement tool designed to help healthcare purchasers and consumers compare quality offered by different plans.

divides performance measures into 8 domains, and organizes reporting measures under these domains.

is updated annually and measures are changed or new measures added.

UCR fee

Capitation fee

Discounted fee-for-service

Keith shall be entitled to Part A benefits when he attains 65 years of age

Keith's wife shall be entitled to Part A benefits when she attains 65 years of age

Keith's wife shall be required to pay a monthly premium in order to receive Medicare Part A benefits

General medical care that is provided directly to a patient without referral from another physician

Also known as secondary care (Medical care that is delivered by specialist)

Outpatient services provided by a hospital or other qualified ambulatory care facility which require inpatient stay

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

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.

Is regulated under federal HMO legislation

Has no provider network of physicians

Is not subject to state insurance laws

Physician Practice Management Compare

Physician Hospital Organization

None of the above

At the end of a rating period, the financial gains and losses experienced by the group during that rating period and, if the group's experience during the period is better than expected, refund part of the group's premium in the form of an experience ratio

Use Robust's average experience with all groups to calculate this particular group's premium.

All of the above

A, B, and C

A and B only

A and C only

PCCMs contract directly with the federal government to provide case management services to Medicaid recipients

all Medicaid recipients who live in rural areas must be given a choice of at least four PCCMs

PCCMs typically receive a case management fee, rather than reimbursement for medical services on a FFS basis, for the services they provide to Medicaid recipients

False

reporting management information about services provided each time a patient visits a provider for purposes of analyzing utilization and provider practice patterns

routinely reviewing and processing a claim for either payment or denial

assigning to each diagnosis or treatment reported on a claim special codes that briefly and specifically describe each diagnosis and treatment

Houston is required to purchase stop-loss insurance to cover its losses under this group health plan

Dallas is the plan's sponsor

Houston's plan is not exempt from any state insurance regulations under ERISA

Codes

Lists

Checks

a closed-panel HMO

a direct contract model HMO

a dual choice HMO

chief executive officer (CEO)

board of directors

director of operations

The Women's Health and Cancer Rights Act (WHCRA) of 1998 requires health plans to offer mastectomy benefits.

The Health Care Quality Improvement Act (HCQIA) requires hospitals, group practices, and HMOs to comply with all standard antitrust legislation, even if these entities adhere to due process standards that are outlined in HCQIA.

The Newborns' and Mothers' Health Protection Act (NMHPA) of 1996 mandates that coverage for hospital stays for childbirth must generally be a minimum of 24 hours for normal deliveries and 48 hours for cesarean births.

Employers with more than 15 employees engaged in interstate commerce need to comply

Pregnancy Discrimination Act (an amendment to this act) requires health plans to provide coverage during childbirth and related medical conditions on the same basis as they provide coverage for other medical conditions

Protects all employees

all health plans, healthcare providers, and healthcare clearinghouses from using any protected health information for purposes of treatment, payment, or healthcare operations without an individual's written consent

patients from requesting that restrictions be placed on the accessibility and use of protected health information

transmission of individually identifiable health information for purposes other than treatment, payment, or healthcare operations without the individual's written authorization