AHM-510 Online Practice Questions and Answers

In the paragraph below, a statement contains two pairs of terms enclosed in parentheses. Determine which term in each pair correctly completes the statement. Then select the answer choice containing the two terms that you have chosen.

One type of acquisition is called a stock purchase. In a typical stock purchase, a company acquires (51% / 100%) of the voting shares of another company's stock, thereby making the acquired company a subsidiary. The (acquired / acquiring) company holds all of the assets and liabilities of the acquired company.

A. 51% / acquired

B. 51% / acquiring

C. 100% / acquired

D. 100% / acquiring

The Surrey Medical Supply Company was formed as a limited partnership. In this partnership, Victoria Lewin is one of the limited partners and Oscar Gould is a general partner. This information indicates that, with respect to the typical characteristics of limited partnerships,

A. Ms. Lewin has more freedom to opt out of the partnership than does Mr. Gould

B. Ms. Lewin has more liability for the debts of Surrey than does Mr. Gould

C. both Ms. Lewin and Mr. Gould participate in the day-to-day management of Surrey

D. the partnership will continue upon the death of Mr. Gould, whereas it will end with the death of Ms. Lewin

Greenpath Health Services, Inc., an HMO, recently terminated some providers from its network in response to the changing enrollment and geographic needs of the plan. A provision in Greenpath's contracts with its healthcare providers states that Greenpath can terminate the contract at any time, without providing any reason for the termination, by giving the other party a specified period of notice.

The state in which Greenpath operates has an HMO statute that is patterned on the NAIC HMO Model Act, which requires Greenpath to notify enrollees of any material change in its provider network. As required by the HMO Model Act, the state insurance department is conducting an examination of Greenpath's operations. The scope of the on-site examination covers all aspects of Greenpath's market conduct operations, including its compliance with regulatory requirements.

With respect to the type of change that constitutes a material change under the HMO Model Act's disclosure requirements, the termination of one healthcare provider from Greenpath's provider network

A. Always qualifies as a material change in the plan, and Greenpath must report the change to all plan enrollees

B. Always qualifies as a material change in the plan, and Greenpath must report the change to only those plan enrollees who have received care from the terminated provider

C. Qualifies as a material change in the plan only if the provider is a primary care provider, and in such a case Greenpath must report the change to all plan enrollees

D. Qualifies as a material change in the plan only if the provider is a primary care provider, and in such a case Greenpath must report the change to only those plan enrollees who receive primary care from the terminated provider

Antitrust laws can affect the formation, merger activities, or acquisition initiatives of a health plan. In the United States, the two federal agencies that have the primary responsibility for enforcing antitrust laws are the

A. Internal Revenue Service (IRS) and the Department of Justice (DOJ)

B. Office of Inspector General (OIG) and the Department of Defense (DOD)

C. Federal Trade Commission (FTC) and the Department of Labor (DOL)

D. Federal Trade Commission (FTC) and the Department of Justice (DOJ)

The following situations illustrate per se violations of federal antitrust laws:

Situation A - Two groups of providers agreed among themselves that each provider will do business with health plans only on a fee-for-service basis.

Situation B - In order to avoid competing with each other, two independent, competing physician-hospital organizations (PHOs) divide the geographic areas in which they will market their services.

From the following answer choices, select the response that correctly identifies the types of per se violations illustrated by these situations.

A. Situation A: price fixing; Situation B: horizontal division of markets

B. Situation A: price fixing; Situation B: tying arrangement

C. Situation A: horizontal group boycott; Situation B: horizontal division of markets

D. Situation A: horizontal group boycott; Situation B: tying arrangement

Health plans should monitor changes in the environment and emerging trends, because changes in society will affect the managed care industry. One true statement regarding recent changes in the environment in which health plans operate is that

A. Women as a group receive more healthcare and interact more often with health plans than do men over the course of a lifetime

B. The focus of healthcare during the past decade has shifted away from outpatient care to inpatient hospital treatment

C. The uninsured population in the United States has been decreasing in recent years

D. The decline in overall inflation in the 1990s failed to slow the growth in healthcare inflation

The Westchester Health Plan is using a pricing strategy that involves setting a low price in a highly price-sensitive market to stimulate revenue growth. In following this strategy, Westchester is sacrificing short-term profits for fast growth in selected markets. This information indicates that Westchester is following the pricing strategy known as

A. Market skimming

B. Buying market share

C. Price skimming

D. Unitary pricing

In examining accountability in the current managed care environment, one is likely to find that combinations of various models of accountability are in operation. Under one model of accountability, the primary mechanisms for accountability are the mechanisms of the marketplace-failure to meet standards will result in a loss of demand for services. By definition, this model of accountability is called the

A. Professional model of accountability

B. Political model of accountability

C. Due diligence model of accountability

D. Economic model of accountability

The Good and Well Pharmacy, a Medicaid provider of outpatient drugs, is subject to the prospective drug utilization review (DUR) mandates of the Omnibus Budget Reconciliation Act of 1990 (OBRA '90). One component of prospective DUR is screening. In this context, when Good and Well is involved in the process of screening, the pharmacy is

A. Updating a formulary to represent the current clinical judgment of providers and experts in the diagnosis and treatment of disease

B. Reviewing patient profiles for the purpose of identifying potential problems

C. Consulting directly with prescribers and patients in the planning of drug therapy

D. Denying coverage for the off-label use of approved drugs

One provision of the Mental Health Parity Act of 1996 (MHPA) is that the MHPA prohibits group health plans from

A. Setting a cap for a group member's lifetime medical health benefits that is higher than the cap for the member's lifetime mental health benefits

B. Imposing limits on the number of days or visits for mental health treatment

C. Charging deductibles for mental health benefits that are higher than the deductibles for medical benefits

D. Imposing annual limits on the number of outpatient visits and inpatient hospital stays for mental health services