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AHM-250
Healthcare Management: An Introduction Questions and Answers

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Viewing page 11 out of 11 pages

Viewing questions 101-110 out of questions

Questions # 101:

Which of the following is(are) CORRECT?

(A) Staff model HMOs can achieve maximum economies of scale but are heavily capital intensive.

(B) Staff model HMOs are closed panel.

Options:

A & B

None of the listed options

B & C

All of the listed options

Answer

Questions # 102:

The National Association of Insurance Commissioners (NAIC) developed the Small Group Model Act to enable small groups to obtain accessible, yet affordable, group health benefits. The model law limits the rate spread, which is the difference between the highest and lowest rates that a health plan charges small groups, to a particular ratio.

According to the Model Act, for example, if the lowest rate an HMO charges a small group for a given set of medical benefits is $40, then the maximum rate the HMO can charge for the same set of benefits is

Options:

$60

$80

$120

$160

Answer

Questions # 103:

The following statements pertain to the federal requirements for minimum deductible & maximum out of pocket expeses for a high deductible health plan in the year 2006. Select the correct answer from the options given below.

Options:

Minimum deductible - $ 1,050 for self only coverage ; maximum out of pocket expenses- $ 2,100 for self only coverage

Minimum deductible - $ 1,050 for self only coverage ; maximum out of pocket expenses- $ 10.500 for family coverage

Minimum deductible - $ 2,100 for self only coverage ; maximum out of pocket expenses- $ 10,500 for self only coverage

Minimum deductible - $ 2,100 for self only coverage ; maximum out of pocket expenses- $ 5,250 for self only coverage

Answer

Questions # 104:

The following statements apply to enrollment statistics for HSAs. Select the answer choice that contains the CORRECT statement.

Options:

HSAs have helped expand health care coverage to consumers who were previously uninsured.

The vast majority of enrollees in HSA health plans are wealthy.

Most people receiving coverage through HSA health plans are individuals rather than families.

HSAs appeal primarily to young consumers.

Answer

Questions # 105:

The following statements are about the underwriting function within a health plan. Select the answer choice containing the correct statement.

Options:

The underwriting function in a health plan is primarily concerned with ensuring that the group being underwritten does not include any individuals who are likely to have higher than average utilization of medical services.

Compared to a health plan with relaxed underwriting requirements, a similar health plan with very strict underwriting requirements can expect to experience increased healthcare costs and to have significantly higher plan enrollment.

Typically, a health plan guarantees the premium rate for a group health contract for a period of no more than six months.

In order to determine the actual premium to charge a group, a group underwriter typically considers such factors as level of participation, benefits, and the age and gender distribution of group members.

Answer

Questions # 106:

The Military Health System of the Department of Defense offers ongoing healthcare coverage to military personnel and their families through the

Options:

Health Care Quality Improvement Program (HCQIP)

Health Plan Management System (HPMS)

TRICARE healthcare system

Health Care Prepayment Plan (HCPP)

Answer

Questions # 107:

Graff Scott is a member of the ABC Health Plan. Whenever she needs non-emergency medical care, sees Dr. Michael Chan, an internist. Ms. Scott cannot self-refer to a specialist, so she saw Dr. Michael Chan when she experienced headaches. Dr. Michael Chan referred her to Dr. Bruce Lee, a neurologist, who had hospitalized at the Polo Hospital for tests. ABC has contracts with Dr. Michael Chan, Dr. Lee, and Polo to provide medical services to its members. The following statements are about Polo's organized system of healthcare. Select the answer choice containing the correct statement

Options:

Within Polo's system, Ms. Scott received primary care from both Dr. Michael Chan and Dr. Lee

Polo's system allows its members open access to all of Ultra's participating providers

Polo's network of providers includes Dr. Michael Chan and Dr. Lee but not Polo Hospital

Within Polo's system, Dr. Michael Chan serves as a coordinator of care or gatekeeper for the medical services that Ms. Scott receives

Answer

Questions # 108:

Traditional Medicare includes two parts: Medicare Part A and Medicare Part B. With regard to the ways these parts differ from each other, it is correct to say that Medicare Part A

Options:

provides benefits for physicians' professional services, whereas Medicare Part B provides basic hospitalization insurance

is financed through premiums paid by covered persons and from the federal government's general tax revenues, whereas Medicare Part B is funded primarily through a payroll tax imposed on employers and workers

provides 100% coverage for eligible medical expenses, whereas Medicare Part B includes annual deductible and coinsurance provisions

is provided automatically to most eligible persons, whereas Medicare Part B is a voluntary program

Answer

Questions # 109:

Maternity management programs are commonly included in?

Options:

Screening Programs

Health promotion Programs

Immunization programs

Answer

Questions # 110:

What is a mathematical process that involves using a number of hypothetical situations that, in total, will reasonably reflect an event that will occur in real life