Free Healthcare Management: An Introduction Exam AHM-250 Exam Practice Test

Al Marak, a member of the Frazier Health Plan, has asked for a typical Level One appeal of a decision that Frazier made regarding Mr. Marak's coverage. One true statement about this Level One appeal is that

• Mr. Marak has the right to appeal to the next level if the Level One appeal upholds the original decision
• It requires Frazier and Mr. Marak to submit to arbitration in order to resolve the dispute
• It is considered to be an informal appeal
• It will be handled by an independent review organization (IRO)

The Neptune Hospital provides medical care to paying patients, as well as to people who either have no healthcare coverage and cannot afford to pay for the care by themselves or who receive services at reduced rates because they are covered under govern me

• cost shifting
• Anti selection
• receivership
• Underwriting

The Employee Retirement Income Security Act (ERISA) requires health plan members who receive healthcare benefits through employee benefit plans to file legal challenges involving coverage decisions or plan administration at the federal level. Under the te

• contract damages, which cover the cost of denied treatment
• compensatory damages, which compensate the injured party for his or her injuries
• punitive damages, which are designed to punish or make an example of the wrongdoer
• all of the above

The Hill Health Plan designed a set of benefits that it packaged in the form of a PPO product. Hill then established a pricing structure that allowed its product to compete in the small group market, and it developed advertising designed to inform potential

• $140
• $170
• $180
• $210

Utilization review offers health plans a means of managing costs by managing

• Cost effectiveness of healthcare services.
• Cost of paying healthcare benefits.
• Both of the above

The process that Mr. Sybex used to identify and classify the risk represented by the Koster Group so that Intuitive can charge premiums that are adequate to cover its expected costs is known as

• coinsurance
• plan funding
• underwriting
• pooling

The following statements apply to Archer medical savings accounts. Select the answer choice that contains the correct statement.

• MSAs were established as a demonstration project under the Medicare Modernization Act.
• MSAs were seen as an improvement over FSAs because they are portable, allowing employees to take the funds with them when they change jobs.
• The popularity of MSAs has been limited because funds may not be rolled over from year to year.
• MSAs are one of the fastest growing Types of Consumer-Directed Health Plans.

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

• Has many contracting options available.
• Should not contract with that entity
• Most likely needs to contract with that entity
• Should attempt to disband the existing affiliations

The application of health plan principles to workers' compensation insurance programs has presented some unique challenges because of the differences between health plan for traditional group healthcare and workers' compensation. One key difference is that

• limits coverage to eligible employees and excludes part-time employees
• specifies an annual lifetime benefit maximum on dollar coverage for medical costs
• provides benefits regardless of the cause of an injury or illness
• provides benefits for both healthcare costs and lost wages

One of the most influential pieces of legislation in the advancement of health plans within the United States was the Health Maintenance Organization (HMO) Act of 1973. One of the provisions of the Act was that it

• exempted HMOs from all state licensure requirements.
• required all employers that offered healthcare coverage to their employees to offer only one type of federally qualified HMO.
• eliminated funding that supported the planning and start-up phases of new HMOs.
• established a process by which HMOs could obtain federal qualification