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AHM-250
Healthcare Management: An Introduction Questions and Answers

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Viewing questions 41-50 out of questions

Questions # 41:

The Ark Health Plan, is currently recruiting providers in preparation for its expansion into a new service area. A recruiter for Ark has been meeting with Dr. Nan Shea, a pediatrician who practices in Ark's new service area, in order to convince her to be

Options:

Has ever participated in any quality improvement activities.

Is a participating provider in a health plan that will compete with Ark in its new service area.

Meets the requirements of the Ethics in Patient Referrals Act.

Has had a medical malpractice claim filed or other disciplinary actions taken against her.

Answer

Questions # 42:

Phoebe Urich is covered by a traditional indemnity health insurance plan that specifies a $500 calendar-year deductible and includes a 20% coinsurance provision. When Ms. Urich was hospitalized, she incurred $3,000 in medical expenses that were covered by

Options:

1900

2000

2400

2500

Answer

Questions # 43:

One ethical principle in managed care is the principle of justice/equity, which specifically holds that MCOs and their providers have a duty to

Options:

treat each member in a manner that respects his or her own goals and values

allocate resources in a way that fairly distributes benefits and burdens among the members

present information honestly to their members and to honor commitments to their members

make sure they do not harm their members

Answer

Questions # 44:

One component of information systems used by health plans incorporates membership data and information about provider reimbursement arrangements and analyzes transactions according to contract rules. This information system component is known as

Options:

A contract management system

A credentialing system

A legacy system

An interoperable communication system

Answer

Questions # 45:

One feature of the Employee Retirement Income Security Act (ERISA) is that it:

Options:

Requires self-funded employee benefit plans to pay premium taxes at the state level.

Contains a pre-emption provision, which typically makes the terms of ERISA take precedence over any state laws that regulate employee welfare benefit plans.

Contains strict reporting and disclosure requirements for all employee benefit plans except health plans.

Requires that state insurance laws apply to all employee benefit plans except insured plans.

Answer

Questions # 46:

One of the most influential pieces of legislation in the advancement of health plans within the United States was the Health Maintenance Organization (HMO) Act of 1973. One of the provisions of the Act was that it

Options:

exempted HMOs from all state licensure requirements.

required all employers that offered healthcare coverage to their employees to offer only one type of federally qualified HMO.

eliminated funding that supported the planning and start-up phases of new HMOs.

established a process by which HMOs could obtain federal qualification

Answer

Questions # 47:

One factor the Sandpiper Health Plan uses to assess its quality is a clinician's bedside manner, i.e., how friendly and understanding the clinician is, whether the patient feels that the clinician listens to the patient's concerns, how well the clinical

Options:

a provider service quality issue

an administrative service quality issue a healthcare process quality issue

a healthcare outcomes quality issue

a healthcare process quality issue

Answer

Questions # 48:

Primary care case managers (PCCMs) provide managed healthcare services to eligible Medicaid recipients. With regard to PCCMs, it is correct to say that

Options:

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

Medicaid PCCM programs are exempt from the Health Care Financing Administration's (HCFA's) Quality Improvement System for Managed Care (QISMC) standards

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

Answer

Questions # 49:

One characteristic of disease management programs is that they typically

Options:

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

use clinical practice processes to standardize the implementation of best practices among providers

Answer

Questions # 50:

PBM plans operate under several types of contractual arrangements. Under one contractual arrangement, the PBM plan and the employer agree on a target cost per employee per month. If the actual cost per employee per month is greater than the target cost, t