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AHM-250
Healthcare Management: An Introduction Questions and Answers

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Viewing questions 31-40 out of questions

Questions # 31:

Health savings accounts were created by which of the following laws:

Options:

COBRA

HIPAA

Medicare Modernization Act

None of the Above

Answer

Questions # 32:

From the following choices, choose the definition that best matches the term Screening

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 # 33:

Health plans can organize under a not-for-profit form or a for-profit form. One true statement regarding not-for-profit health plans is that these organizations typically

Options:

are exempt from review by the Internal Revenue Service (IRS)

are organized as stock companies for greater flexibility in raising capital

rely on income from operations for the large cash outlays needed to fund long-term projects and expansion

engage in lobbying or political activities in order to maintain their tax-exempt status

Answer

Questions # 34:

Allgood Medical, Inc., a health plan, has contracted with Mercy Memorial Hospital to provide inpatient medical services to Allgood's plan members. The terms of the contract specify that Allgood will reimburse Mercy Memorial on the basis of a negotiated ch

Options:

per diem agreement

fee-for-service agreement

withhold agreement

diagnostic related group (DRG) agreement

Answer

Questions # 35:

Health plans often program into their claims processing systems certain criteria that, if unmet, will prompt further investigation of a claim. In an automated claims processing system, these criteria may signal the need for further review when, for example

Options:

Encounter reports

Diagnostic codes

Durational ratings

Edits

Answer

Questions # 36:

Before the Hill 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:

Hill had to have an initial net worth of at least $1.5 million in order to obtain a COA.

The COA most likely exempts Hill from any of State X's enabling statutes.

Hill had to be organized as a partnership in order to obtain a COA

The COA in no way indicates that Hill has demonstrated that it is fiscally sound.

Answer

Questions # 37:

In claims administration terminology, a claims investigation is correctly defined as the process of

Options:

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

obtaining all the information necessary to determine the appropriate amount to pay on a given claim

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

Answer

Questions # 38:

One true statement regarding ethics and laws is that the values of a community are reflected in

Options:

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

both ethics and laws, but only 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

Answer

Questions # 39:

The following organizations are the primary sources of accreditation of healthcare organizations:

Options:

National Committee for Quality Assurance (NCQA)

American Accreditation HealthCare Commission/URAC Of these organizations, performance data is included i

A only

B only

A and B

none of the above

Answer

Questions # 40:

Patrick Flaherty's employer has contracted to receive healthcare for its employees from the Abundant Healthcare System. Mr. Flaherty visits his primary care physician (PCP), who sends him to have some blood tests. The PCP then refers Mr. Flaherty to a special