AHM-250 Online Practice Questions and Answers

Before an HMO contracts with a physician, the HMO first verifies the physician's credentials.

Upon becoming part of the HMO's organized system of healthcare, the physician is typically subject to

A. both recredentialing and peer review

B. recredentialing only

C. peer review only

D. neither recredentialing nor peer review

Federal Employee Health Benefits Program (FEHBP) requires health plans offering services to federal employees and their dependents to provide

A. Immediate access to emergency services

B. Urgent Appointments within 24 hours

C. Routine appointments once a m

D. D

E. A

F. B and C

G. All of the listed options

One of the distinguishing characteristics of healthcare marketing is that many of the markets for health plans are national, not local markets.

A. True

B. False

One non-group market segment to which health plans market health plan products is the senior market, which is comprised mostly of persons over age 65 who are eligible for Medicare benefits. One factor that affects a health plan's efforts to market to the

A. The Centers for Medicare and Medicaid Services (CMS) must approve all marketing materials used by health plans to market health plan products to the Medicare population

B. managed Medicare plans typically require Medicare beneficiaries to purchase Medigap insurance to supplement gaps in coverage

C. managed Medicare plans can refuse to cover persons with certain health problems

D. the CMS prohibits health plans from using telemarketing to market health plan products to the Medicare population

Merle Spencer has coverage under both Medicare Part A and Medicare Part B. Ms. Spencer recently was hospitalized for chest pains, and she incurred charges for:

The cost of hospitalization for two days Diagnostic tests performed in the hospital Trans

A. ambulance and the diagnostic tests

B. ambulance, the diagnostic tests, and the physician's professional services

C. cost of hospitalization

D. cost of hospitalization and the physician's professional services

Diabetic patients with high glucose levels requiring stabilization following treatment of an acute attack would best be served in an ___________

A. Emergency Department

B. Urgent Care Centre

C. Hospice Care

D. Observation Care Unit

The provision of mental health and chemical dependency services is collectively known as behavioral healthcare. The following statements are about behavioral healthcare. Three of these statements are true and one statement is false. Select the answer choice

A. Factors that have increased the demand for behavioral healthcare services include increased stress on individuals and families and the increasing availability of behavioral healthcare services.

B. To manage the delivery of behavioral healthcare services, managed behavioral health organizations (MBHOs) use only two basic strategies: alternative treatment levels and crisis intervention.

C. The treatment approaches for behavioral healthcare most often include drug therapy, psychotherapy, and counseling.

D. The development of alternative treatment options, incorporation of community-based resources into the healthcare system, and increased reliance on case management have shifted the emphasis of managed behavioral healthcare from meeting the service needs of

In the CPT system, each service or procedure is identified by

A. Three-digit with decimal point

B. Three-digit

C. Five-digit with decimal point

D. Five-digit

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

A. 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.

B. 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.

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

D. 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.

Types of alternative care centers include urgent care centers, observation care units, and stepdown units. One difference between the costs associated with alternative care centers is that, compared to the cost of:

A. Facilities, equipment, and staffing in hospital emergency departments (EDs), the cost of facilities, equipment, and staffing in observation care units is generally lower

B. Care delivered in urgent care centers, the cost of care delivered in hospital emergency departments (EDs) is generally lower.

C. Care in step-down units, the cost of acute inpatient care is generally lower.

D. Primary care in a physician's office, the cost of care delivered in urgent care centers is generally lower.