Regenerate AHM-250 Interactive Bootcamp 2021

NEW QUESTION 1

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

• A. are exempt from review by the Internal Revenue Service (IRS)
• B. are organized as stock companies for greater flexibility in raising capital
• C. rely on income from operations for the large cash outlays needed to fund long-term projects and expansion
• D. engage in lobbying or political activities in order to maintain their tax-exempt status

Answer: C

NEW QUESTION 2

In the paragraph below, two statements each contain a pair of terms enclosed in parentheses. Determine which term correctly completes each statement. Then select the answer choice containing the two terms that you have chosen. For providers, (operational /

• A. operational / an acquisition
• B. operational / a consolidation
• C. structural / an acquisition
• D. structural / a consolidation

Answer: D

NEW QUESTION 3

In most cases, medical errors are caused by breakdowns in the healthcare system rather than by provider mistakes.

• A. True
• B. False

Answer: A

NEW QUESTION 4

Advantages of EDI over manual data management systems

• A. Speed of data refer
• B. Loss of data integrity
• C. All of the above
• D. None of the above

Answer: B

NEW QUESTION 5

In preparation for its expansion into a new service area, the Regal MCO is meeting with Dr. Nancy Buhner, a cardiologist who practices in Regal's new service area, in order to convince her to become one of the plan's participating providers. As part of the

• A. ensure that D
• B. Buhner complies with all of the provisions of the Ethics in Patient Referrals Act
• C. learn whether D
• D. Buhner is a licensed medical practitioner
• E. confirm D
• F. Buhner's membership in the National Committee for Quality Assurance (NCQA)
• G. learn whether D
• H. Buhner has had a medical malpractice claim filed or other disciplinary actions taken against her

Answer: D

NEW QUESTION 6

The Granite Health Plan is a coordinated care plan (CCP) that participates in the Medicare+Choice program. This information indicates that Granite

• A. must comply with all state-mandated benefits and provider requirements
• B. must offer each of its enrollees a Medicare supplement
• C. places primary care t the censer of the delivery system and focuses on managing patient care at all levels
• D. most likely must cover Medicare Part A, but not Medicare Part B, benefits

Answer: C

NEW QUESTION 7

The following statements are about the various Health Plan Accountability Models adopted by the NAIC.

• A. Under the terms of the Health Plan Network Adequacy Model Act, all health plans would be required to hold covered persons harmless against provider collections and provide continued coverage for uncompleted treatment in the event of plan insolvency
• B. The Health Carrier Grievance Procedure Model Act requires all health carriers to maintain a first-level grievance review, but it does not require any second-level review
• C. According to the Health Care Professional Credentialing Verification Model Act, a health plan must select all providers who meet the plan's credentialing criteria
• D. The Quality Assessment and Improvement Model Act exempts closed plans from
• E. implementing a quality improvement program.

Answer: A

NEW QUESTION 8

Individuals can use HSAs to pay for the following types of health coverage:.

• A. Qualified disability insurance
• B. COBRA continuation coverage.
• C. Medigap coverage (for those over 65).
• D. All of the above.

Answer: B

NEW QUESTION 9

The Military Health System of the Department of Defense offers ongoing healthcare coverage to military personnel and their families through the

• A. Health Care Quality Improvement Program (HCQIP)
• B. Health Plan Management System (HPMS)
• C. TRICARE healthcare system
• D. Health Care Prepayment Plan (HCPP)

Answer: C

NEW QUESTION 10

Which of the following is NOT a preventive care initiative often used by health plans?

• A. Screening for high blood pressure
• B. Maternity management programs
• C. Vaccines
• D. Physical therapy

Answer: D

NEW QUESTION 11

HMOs typically employ several techniques to manage provider utilization and member utilization of medical services. One technique that an HMO uses to manage member utilization is

• A. the use of physician practice guidelines
• B. the requirement of copayments for office visits
• C. capitation
• D. risk pools

Answer: B

NEW QUESTION 12

Exclusive provider organizations (EPO) is similar and operates like a PPO in administration, structure but however in an EPO an out-of-network care is

• A. Partially Covered
• B. Covered with more out of pocket
• C. Not covered

Answer: C

NEW QUESTION 13

Emily Brown works for Integral Health Plan and represents the company as a board member for the board of directors. Which best describes Emily's position?

• A. Community Representative
• B. Inside Director
• C. Outside Director
• D. None of these

Answer: B

NEW QUESTION 14

The National Association of Insurance Commissioners' (NAIC's) Unfair Claims Settlement Practices Act specifies standards for the investigation and handling of claims. The Act defines unfair claims practices and notes that such practices are improper if the

• A. Both A and B
• B. A only
• C. B only
• D. Neither A nor B

Answer: A

NEW QUESTION 15

What are the characteristics that the underwriter has to consider while determining the premium rate for health insurance coverage for a group?

• A. Level of benefits
• B. Geographic location
• C. Group size
• D. All the above

Answer: D

NEW QUESTION 16

The following statements are about information management in health plans. Three of the statements are true and one statement is false. Select the answer choice containing the FALSE statement:

• A. Health plans find EDI useful for transmitting data among different health plan locations.
• B. EDI is different from eCommerce in the EDI is the transfer of data, typically in batches, while ecommerce is a back-and-forth exchange of information concerning individual transactions.
• C. The majority of health plan eCommerce occurs via proprietary computer networks.
• D. Benefits that health plans can receive from using electronic data interchange.

Answer: C

NEW QUESTION 17

Combined system of preventive, diagnostic and therapeutic measures that focuses on management of specific chronic illness or medical conditions are:

• A. Utilization Review
• B. Case Management
• C. Demand Management
• D. Disease management

Answer: B

NEW QUESTION 18

An HMO that combines characteristics of two or more HMO models is sometimes referred to as a

• A. Network model HMO
• B. Group model HMO
• C. Staff model HMO
• D. Mixed model HMO

Answer: D

NEW QUESTION 19

Amendments to the HMO act 1973 do not permit federally qualified HMO’s to use

• A. Retrospective experience rating
• B. Adjusted community rating
• C. Community rating by class
• D. Community rating

Answer: A

NEW QUESTION 20

If a state commissioner of insurance places an HMO under administrative supervision, then the purpose of this action most likely is to:

• A. Transfer all of the HMO's business to other carriers.
• B. Allow the state commissioner, acting for a state court, to take control of and administer the HMO's assets and liabilities.
• C. Sell the HMO's assets in order to satisfy the HMO's obligations.
• D. Place the HMO's operations under the direction and control of the state commissioner or a person appointed by the commissioner.

Answer: D

NEW QUESTION 21

Khalyn Drury's employer includes managed dental care in its employee benefits package. During open enrollment, Ms. Drury enrolled in the dental plan, which provides dental services to its members in exchange for a prepayment (the premium). Dental services

• A. dental preferred provider organization (PPO)
• B. traditional fee-for-service (FFS) dental plan
• C. plan with a dental point of service (POS) option
• D. dental health maintenance organization (DHMO)

Answer: D

NEW QUESTION 22

Because many patients with behavioral health disorders do not require round-the-clock nursing care and supervision, behavioral healthcare services can be delivered effectively in a variety of settings. For example, post-acute care for behavioral health di

• A. Hospital observation units or psychiatric hospitals.
• B. Psychiatric hospitals or rehabilitation hospitals.
• C. Subacute care facilities or skilled nursing facilities.
• D. Psychiatric units in general hospitals or hospital observation units.

Answer: C

NEW QUESTION 23

The parties to the contractual relationship that provides Castle's group health coverage to Knoll employees are

• A. Castle and Knoll only
• B. Knoll and all covered Knoll employees only
• C. Castle, Knoll, and all covered Knoll employees
• D. Castle and all covered Knoll employees only

Answer: A

NEW QUESTION 24

Natalie Chan is a member of the Ultra Health Plan. Whenever she needs non-emergency medical care, she sees Dr. David Craig, an internist. Ms. Chan cannot self-refer to a
specialist, so she saw Dr. Craig when she experienced headaches. Dr. Craig referred h

• A. Within Ultra's system, M
• B. Chan received primary care from both D
• C. Craig and D
• D. Lee.
• E. Ultra's system allows its members open access to all of Ultra's participating providers.
• F. Within Ultra's system, D
• G. Craig serves as a coordinator of care or gatekeeper for the medical services that M
• H. Chan receives.
• I. Ultra's network of providers includes D
• J. Craig and D
• K. Lee but not Arrow Hospital.

Answer: C

NEW QUESTION 25

One way in which a health plan can support an ethical environment is by

• A. requiring organizations with which it contracts to adopt the plan's formal ethical policy
• B. developing and maintaining a culture where ethical considerations are integrated into decision making at the top organizational level only
• C. establishing a formal method of managing ethical conflicts, such as using an ethics task force or bioethics consultant
• D. maintaining control of policy development by removing providers and members from the process of developing and implementing policies and procedures that provide guidance to providers and members confronted with ethical issues

Answer: C

NEW QUESTION 26
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