AHM-250無料問題集「AHIP Healthcare Management: An Introduction」

質問 1

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

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

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

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

（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

正解：A 解答を投票する

質問 2

Consolidation of patient information in a single location as can be used by independent providers is an example of

（A）Operational Integration

（B）None of the above

（C）Structural Integration

（D）Business Integration

正解：B 解答を投票する

質問 3

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The following programs are part of the Alcove MCO's utilization management (UM) program:
A telephone triage program
Preventive care initiatives
A shared decision-making program
A self-care program
With regard to the UM programs, it is most likely cor

（A）shared decision-making program is appropriate for virtually any medical condition

（B）self-care program is intended to complement physicians' services, rather than to supercede or eliminate these services

（C）preventive care initiatives include immunization programs but not health promotion programs

（D）telephone triage program is staffed by physicians only

正解：B 解答を投票する

質問 4

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

（A）Hill's ability to report utilization data.

（B）The price for the PPO product.

（C）The number of specialists in Hill's network of providers.

（D）Hill's use of brokers to market its PPO product.

正解：B 解答を投票する

質問 5

Ian Vladmir wants to have a routine physical examination to ascertain that he is in good health. Mr. Vladmir is a member of a health plan that will allow him to select the physician of his choice, either from within his plan's network or from outside of h

（A）a traditional HMO plan

（B）a point of service (POS) option

（C）a managed indemnity plan

（D）an exclusive provider organization (EPO)

正解：B 解答を投票する

解説: (JPNTest メンバーにのみ表示されます)

質問 6

Managed behavioral health organizations (MBHOs) use several strategies to manage the delivery of behavioral healthcare services. The following statements are about these strategies.
Select the answer choice that contains the correct statement.

（A）The level of care needed to treat behavioral disorders is the same for all patients and all disorders.

（B）By using outpatient treatment more extensively, MBHOs have decreased the use of costly inpatient therapies.

（C）PCP gatekeeper systems for behavioral healthcare generally result in more accurate diagnoses, more effective treatment, and more efficient use of resources than do centralized referral systems.

（D）MBHOs generally provide benefits for mental health services but not for chemical dependency services.

正解：B 解答を投票する

質問 7

Prescription drug benefits in Medicare can be obtained through:

（A）Traditional fee for service (FFS) Medicare

（B）Stand alone prescription drug pl (PDPs)

（C）Both A & C

（D）Medicare Advantage pl

正解：B 解答を投票する

質問 8

In the paragraph below, a sentence contains two pairs of words enclosed in parentheses. Determine which word in each pair correctly completes the sentence. Then select the answer choice containing the two words that you have chosen. Many pharmacy benefit

（A）Generic / never

（B）Therapeutic / never

（C）Therapeutic / always

（D）Generic / always

正解：C 解答を投票する

質問 9

Parul Gupta has been covered by a group health plan for eighteen months. For the past four months, she has been undergoing treatment for diabetes. Last week, Ms. Gupta began a new job and immediately enrolled in her new company's group health plan, which

（A）can exclude coverage for treatment of Ms. Gupta's diabetes for four months, because that is the length of time she received treatment for this medical condition prior to her enrollment in the new health plan

（B）can exclude coverage for treatment of Ms. Gupta's diabetes for one year, because HIPAA does not impact a group health plan's pre-existing condition provision

（C）can exclude coverage for treatment of Ms. Gupta's diabetes for one year, because she did not have at least two years of creditable coverage under her previous health plan

（D）cannot exclude Ms. Gupta's diabetes as a pre-existing condition, because the one-year pre-existing condition provision is offset by at least one year of continuous coverage under her previous health plan

正解：D 解答を投票する

質問 10

Immediate evaluation and treatment of illness or injury can be provided in any of the following care settings:

（A）Physician's offices

（B）B, C, A

（C）Hospital emergency departments

（D）C, A, B

（E）Urgent care centers If these settings are ranked in order of the cost of providing c

（F）A, C, B

（G）A, B, C

正解：A 解答を投票する

質問 11

The Clover Group is a for-profit MCO that operates in the United States. The Valentine
Group owns all of Clover's stock. The Valentine Group's sole business is the ownership of controlling interests in the shares of other companies. This information indic

（A）sister corporation of the Valentine Group

（B）parent company of the Valentine Group

（C）subsidiary of the Valentine Group

（D）holding company of the Valentine Group

正解：C 解答を投票する

質問 12

To determine fee reimbursements to be paid to physicians, the Triangle Health Plan assigns a weighted value to each medical procedure or service and multiplies the weighted value by a money multiplier. Triangle and the providers negotiate the value of the

（A）Capped fee system

（B）Diagnosis-related group (DRG) system

（C）Relative value scale (RVS)

（D）Partial capitation arrangement

正解：C 解答を投票する

質問 13

The criteria used to identify and measure healthcare quality are generally divided into three categories: structure, process, and outcomes measures. Structure measures, which relate to the nature and quality of the resources that a health plan has available

（A）number of patients contracting an infection in the hospital

（B）percentage of plan physicians who are board-certified

（C）length of time patients have to wait at the office to be seen by a provider

（D）percentage of children receiving immunizations

正解：B 解答を投票する

質問 14

The National Association of Insurance Commissioners (NAIC) developed the Small Group Model Act to enable small groups to obtain accessible, yet affordable, group health benefits. The model law limits the rate spread, which is the difference between the highest and lowest rates that a health plan charges small groups, to a particular ratio.
According to the Model Act, for example, if the lowest rate an HMO charges a small group for a given set of medical benefits is $40, then the maximum rate the HMO can charge for the same set of benefits is

（A）$160

（B）$60

（C）$80

（D）$120

正解：C 解答を投票する

質問 15

The following statements pertain to the federal requirements for minimum deductible & maximum out of pocket expeses for a high deductible health plan in the year 2006. Select the correct answer from the options given below.

（A）Minimum deductible - $ 1,050 for self only coverage ; maximum out of pocket expenses$ 2,100 for self only coverage

（B）Minimum deductible - $ 1,050 for self only coverage ; maximum out of pocket expenses$ 10.500 for family coverage

（C）Minimum deductible - $ 2,100 for self only coverage ; maximum out of pocket expenses$ 10,500 for self only coverage

（D）Minimum deductible - $ 2,100 for self only coverage ; maximum out of pocket expenses$ 5,250 for self only coverage

正解：B 解答を投票する

質問 16

Janet Riva is covered by a indemnity health insurance plan that specifies a $250 deductible and includes a 20% coinsurance provision. When Ms. Riva was hospitalized, she incurred $2,500 in medical expenses that were covered by her health plan. She incurred

（A）$2,000

（B）$1,750

（C）$2,250

（D）$1,800

正解：D 解答を投票する

質問 17

Katrina Lopez is a claims analyst for a health plan that provides a higher level of benefits for services received in-network than for services received out-of-network. Ms. Lopez reviewed a health claim for answers to the following questions:
Question A -

（A）A, B, C, and D

（B）A, B, and D only

（C）A and C only

（D）B, C, and D only

正解：A 解答を投票する

AHM-250 無料問題集「AHIP Healthcare Management: An Introduction」

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