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AHM-250 Exam Dumps - Healthcare Management: An Introduction

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Question # 49

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

A.

a negotiated rebate agreement

B.

a carve-out arrangement

C.

an indemnity plan

D.

PBM

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Question # 50

Primary care case managers (PCCMs) provide managed healthcare services to eligible Medicaid recipients. With regard to PCCMs, it is correct to say that

A.

PCCMs contract directly with the federal government to provide case management services to Medicaid recipients

B.

all Medicaid recipients who live in rural areas must be given a choice of at least four PCCMs

C.

Medicaid PCCM programs are exempt from the Health Care Financing Administration's (HCFA's) Quality Improvement System for Managed Care (QISMC) standards

D.

PCCMs typically receive a case management fee, rather than reimbursement for medical services on a FFS basis, for the services they provide to Medicaid recipients

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Question # 51

The Blaine Healthcare Corporation seeks to manage its quality by first identifying the best practices and best outcomes for a given procedure. Blaine can then determine areas in which it can emulate the best practices in order to equal or surpass the best

A.

provider profiling

B.

benchmarking

C.

peer review

D.

quality assessment

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Question # 52

One ethical principle in managed care is the principle of justice/equity, which specifically holds that MCOs and their providers have a duty to

A.

treat each member in a manner that respects his or her own goals and values

B.

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

C.

present information honestly to their members and to honor commitments to their members

D.

make sure they do not harm their members

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Question # 53

Medicare is the federal government program established under Title XVIII of the Social Security Act of 1965 to provide hospital, medical and other covered benefits to elderly and disabled persons. Medicare is available for:

A.

Persons age 63 or older.

B.

Persons with qualifying disabilities (over the age of 63)

C.

Persons with end-stage renal disease (ESRD)

D.

Low income individuals

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Question # 54

Lansdale Healthcare, a health plan, offers comprehensive healthcare coverage to its members through a network of physicians, hospitals, and other service providers. Plan members who use in-network services pay a copayment for these services. The copayment

A.

specified dollar amount charge that a plan member must pay out-of-pocket for a specified medical service at the time the service is rendered

B.

percentage of the fees for medical services that a plan member must pay after Magellan has paid its share of the costs of those services

C.

flat amount that a plan member must pay each year before Magellan will make any benefit payments on behalf of the plan member

D.

specified payment for services that was negotiated between the provider and Magellan

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Question # 55

The Ark Health Plan, is currently recruiting providers in preparation for its expansion into a new service area. A recruiter for Ark has been meeting with Dr. Nan Shea, a pediatrician who practices in Ark's new service area, in order to convince her to be

A.

Credentialing

B.

Accreditation

C.

A sentinel event

D.

A screening program

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