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AHM-250
Healthcare Management: An Introduction Questions and Answers

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Viewing questions 91-100 out of questions

Questions # 91:

The Madison Health Plan, a national MCO, and a local hospital system that operates its own managed healthcare network recently created a new and separate managed healthcare organization, the Pineapple Health Plan. Madison and the hospital system share own

Options:

a consolidation

a joint venture

a merger

an acquisition

Answer

Questions # 92:

The following statement(s) can correctly be made about the Joint Commission on Accreditation of Healthcare Organizations (JCAHO):

Options:

JCAHO's accreditation process for MCOs and healthcare networks consists of complete on-site surveys conducted every three

A only

Neither A nor B

Both A and B

B only

Answer

Questions # 93:

The National Association of Insurance Commissioners' (NAIC's) Unfair Claims Settlement Practices Act specifies standards for the investigation and handling of claims. The Act defines unfair claims practices and notes that such practices are improper if the

Options:

Both A and B

A only

B only

Neither A nor B

Answer

Questions # 94:

The following statements apply to health reimbursement arrangements. Select the answer choice that contains the correct statement.

Options:

Only employers are permitted to establish and fund HRAs.

The popularity of HRAs waned following a 2002 ruling by U.S. Treasury Department regarding their treatment in the tax code.

HRAs must be offered in conjunction with a high-deductible health plan.

The guaranteed portability feature of HRAs has contributed to their popularity.

Answer

Questions # 95:

Which of the following is an example of physician only model of operational integration?

Options:

Consolidated medical group

Integrated Delivery System

Medical Foundation

Both B & C

Answer

Questions # 96:

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

Options:

An indemnity wraparound plan

A self-funded plan

An aggregate stop-loss plan

A fully funded plan

Answer

Questions # 97:

Which of the following statements is NOT a requirement for a service to be deemed a 'medically necessary service'?

Options:

Furnished in the least intensive type of medical care setting required by the member's condition.

Solely for the convenience of the member.

In accordance with the standards of good medical practice.

Consistent with the symptoms of the member's condition.

Answer

Questions # 98:

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.

Options:

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

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

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

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.

Answer

Questions # 99:

The Houston Company, a United States company, offers its eligible employees health insurance coverage through a group health plan. Houston hired the Dallas Company to handle the plan's claim administration and membership services, but Houston is financial