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AHM-250 Exam Dumps - Healthcare Management: An Introduction

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Question # 25

If most of the physicians, or many of the physicians in a particular specialty, are affiliated with a single entity, then a health plan building a network in the service area _____________.

A.

Has many contracting options available.

B.

Should not contract with that entity

C.

Most likely needs to contract with that entity

D.

Should attempt to disband the existing affiliations

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Question # 26

Eleanor Giambi is covered by a typical 24-hour managed care program. One characteristic of this program is that it:

A.

Provides Ms. Giambi with healthcare coverage for any illness or injury, but only if the cause of the illness or injury is work-related.

B.

Combines the group health plan and disability plan offered by Ms. Giambi's employer with workers' compensation coverage.

C.

Requires Ms. Giambi and her employer to each pay half of the cost of this coverage.

D.

Requires Ms. Giambi to pay specified deductibles and copayments before receiving benefits under this program for any illness or injury.

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Question # 27

For this question, select the answer choice containing the terms that correctly complete the blanks labeled A and B in the paragraph below.

NCQA offers Quality Compass, a national database of performance and accreditation information submitted by managed

A.

Health Plan Employer Data and Information Set (HEDIS) mandatory

B.

Health Plan Employer Data and Information Set (HEDIS) voluntary

C.

ORYX mandatory

D.

ORYX voluntary

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Question # 28

The Stateside Health Plan uses the following outcomes measures to evaluate the quality of its diabetes disease management program.

Measure A: Incidence of foot ulcers among long-term diabetes patients

Measure B: Ability of long-term diabetes patients to m

A.

Measure A clinical status Measure B patient perception

B.

Measure A clinical status Measure B functional status

C.

Measure A functional status Measure B patient perception

D.

Measure A functional status Measure B clinical status

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Question # 29

The following statements are about accreditation in health plans. Select the answer choice that contains the correct statement.

A.

Accreditation is typically performed by a panel of physicians and administrators employed by the health plan under evaluation.

B.

All accrediting organizations use the same standards of accreditation.

C.

Results of accreditation evaluations are provided only to state regulatory agencies and are not made available to the general public.

D.

Accreditation demonstrates to an health plan's external customers that the plan meets established standards for quality care.

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Question # 30

Traditional Medicare includes two parts: Medicare Part A and Medicare Part B. With regard to the ways these parts differ from each other, it is correct to say that Medicare Part A

A.

provides benefits for physicians' professional services, whereas Medicare Part B provides basic hospitalization insurance

B.

is financed through premiums paid by covered persons and from the federal government's general tax revenues, whereas Medicare Part B is funded primarily through a payroll tax imposed on employers and workers

C.

provides 100% coverage for eligible medical expenses, whereas Medicare Part B includes annual deductible and coinsurance provisions

D.

is provided automatically to most eligible persons, whereas Medicare Part B is a voluntary program

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Question # 31

One among the following is a reason that limit access to health care for US people.

A.

Life Style of the people

B.

Concentration of physicians in highly populated areas.

C.

Advancement in information technology

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Question # 32

George was covered by a united health care insurance policy. This policy says that Geroge has to pay $300 out of pocket for the medical expenses in that year before united health care will start to reimburse the medical expense incurred for George. What is the term used to call the out of pocket payment made by George.

A.

Co-payment

B.

Deductible

C.

Coinsurance

D.

None of the above

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