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Pass the AHIP Certification AHM-250 Questions and answers with ExamsMirror

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Viewing page 8 out of 11 pages
Viewing questions 71-80 out of questions
Questions # 71:

The Conquest Corporation contracts with the Apex health plan to provide basic medical and surgical services to Conquest employees. Conquest entered into a separate contract with the Bright Dental Group to provide and manage a dental care program for employee

Options:

A.

a negotiated rebate agreement

B.

a carve-out arrangement

C.

an indemnity plan

D.

PBM

Questions # 72:

Medicaid is a jointly funded federal and state program that provides hospital and medical expense coverage to low-income individuals and certain aged and disabled individuals. One characteristic of Medicaid is that

Options:

A.

providers who care for Medicaid recipients must accept Medicaid payment as payment in full for services rendered

B.

Medicaid requires recipients to pay deductibles, copayments, and coinsurance amounts for all services

C.

Medicaid is always the primary payer of benefits

D.

benefits offered by Medicaid programs are federally mandated and do not vary by state

Questions # 73:

One ethical principle in health plans is the principle of non-malfeasance, which holds that health plans and their providers:

Options:

A.

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

B.

Have a duty to present information honestly and are obligated to honor commitments.

C.

Are obligated not to harm their members.

D.

Should treat each plan member in a manner that respects his or her goals and values.

Questions # 74:

The Fairway Health Group contracted with the Empire Corporation to provide behavioral healthcare services to Empire employees. As a condition of providing behavioral healthcare services, Fairway required Empire to contract with Fairway for basic medical s

Options:

A.

horizontal group boycott

B.

price-fixing agreement

C.

horizontal division of markets

D.

tying arrangement

Questions # 75:

The following statement(s) can correctly be made about the characteristics of reports that should be provided to managers for use in managing a healthcare delivery system:

Options:

A.

Users typically need access to all the raw data used to generate reports

B.

Info

C.

Both A and B

D.

A only

E.

B only

F.

Neither A nor B

Questions # 76:

The following statements describe individuals who are applying for individual health insurance coverage:

Six months ago, Wilbur Lee lost his health insurance coverage due to a reduction in work hours and has exhausted his coverage under COBRA. Mr. Lee has

Options:

A.

both Mr. Lee and Mr. Beeker

B.

Mr. Lee only

C.

Mr. Beeker only

D.

neither Mr. Lee nor Mr. Beeker

Questions # 77:

The following statements describe common types of physician/hospital integrated models: (A) The Alpha Company, which is owned by a group of investors, is a for-profit legal entity that buys entire physician practices, not just the tangible assets of the p

Options:

A.

Physician hospital organization physician practice management company

B.

Physician practice management company physician hospital organization

C.

Medical foundation management services company

D.

Physician hospital organization medical foundation

Questions # 78:

Which of the following people would be considered part of the individual market segment?

Options:

A.

John is eligible for Medicare.

B.

Julie has coverage through an employer group.

C.

James works for an employer that does not offer health coverage.

D.

Jenny is eligible for Medicaid.

Questions # 79:

Common characteristics of POS products are

Options:

A.

Lack of Freedom of choice

B.

Absence of Primary care physician

C.

Cost-cutting efforts and the structure of coverage

D.

All of the above

Questions # 80:

The process that Mr. Sybex used to identify and classify the risk represented by the Koster Group so that Intuitive can charge premiums that are adequate to cover its expected costs is known as

Options:

A.

coinsurance

B.

plan funding

C.

underwriting

D.

pooling

Viewing page 8 out of 11 pages
Viewing questions 71-80 out of questions
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