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AHM-250
Healthcare Management: An Introduction Questions and Answers

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Questions # 1:

Health plans' use of the Internet to provide plan members with health-related information has grown rapidly in recent years. One advantage the Internet has over other forms of communication is that

Options:

users can access the Internet using a number of different types of computer systems

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

Answer

Questions # 2:

As part of its utilization management (UM) system, the Creole Health Plan uses a process known as case management. The following individuals are members of the Creole Health Plan:

Jill Novacek, who has a chronic respiratory condition.

Abraham Rashad.

Options:

Ms. Novacek, Mr. Rashad, and Mr. Devereaux

Ms. Novacek and Mr. Rashad only

Ms. Novacek and Mr. Devereaux only

None of these members

Answer

Questions # 3:

From the following choices, choose the definition that best matches the term health risk assessment (HRA)

Options:

A technique used to educate plan members on how to distinguish between minor problems and serious conditions and effectively treat minor problems themselves

A technique used to determine if a health condition is present even if a member has not experienced symptoms of the problem

A technique in which information about a plan member's health status, personal and family health history, and health-related behaviors is used to predict the member's likelihood of experiencing specific illnesses or injuries

A technique used to evaluate the medical necessity, appropriateness, and cost-effectiveness of healthcare services for a given patient

Answer

Questions # 4:

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

Options:

Prospective review

Concurrent review

A, B, and C

A and B only

A and C only

B only

Answer

Questions # 5:

Health plans may use different capitation arrangements for different levels of service. One typical capitation arrangement provides a capitation payment that may include primary care only, or both primary and secondary care, but not ancillary services. The

Options:

global capitation arrangement

gatekeeper arrangement

carve-out arrangement

partial capitation arrangement

Answer

Questions # 6:

Brokers are one type of distribution channel that health plans use to market their health plans. One true statement about brokers for health plan products is that, typically, brokers

Options:

Are not required to be licensed by the states in which they market health plans

Are compensated on a salary basis

Represent only one health plan or insurer

Are considered to be an agent of the buyer rather than an agent of the health plan or Insurer

Answer

Questions # 7:

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

Options:

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

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

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

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

Answer

Questions # 8:

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

Options:

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

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

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

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

Answer

Questions # 9:

During the risk assessment process for a traditional indemnity group insurance health plan, group underwriters consider such characteristics as a group’s geographic location, the size and gender mix of the group, and the level of participation in the grou

Options:

Healthcare costs are typically higher in rural areas than in large urban areas.

The morbidity rate for males is higher than the morbidity rate for females.

The larger the group, the more likely it is that the group will experience losses similar to the average rate of loss that was predicted.

All of the above

Answer

Questions # 10:

Greentree Medical, a health plan, is currently recruiting PCPs in preparation for its expansion into a new service area. Abigail Davis, a recruiter for Greentree, has been meeting with Melissa Cortelyou, M.D., in an effort to recruit her as a PCP in Green

Options:

Greentree is prevented by law from offering a contract to Dr. Cortelyou until the credentialing process is complete

any contract signed by Dr. Cortelyou should include a clause requiring the successful completion of the credentialing process within a defined time frame in order for the contract to be effective

Greentree must offer a standard contract to Dr. Cortelyou, without regard to the outcome of the credentialing process

Greentree will abandon the credentialing process now that Dr. Cortelyou has agreed to participate in Greentree's network

Answer

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