NO.1 A public employer, such as a municipality or county government would be considered which of
the following?
A. Employer-employee group
B. Multiple-employer group
C. Affinity group
D. Debtor-creditor group
Answer: A
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NO.2 Bill the member for the balance of the fee above the maximum allowable amount under the fee
schedule reimbursement method
A. UCR fee
B. Capitation fee
C. Balance bill
D. Discounted fee-for-service
Answer: C
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NO.3 Utilization management techniques that most HMOs use for hospital providers include:
A. Discharge planning
B. Case management
C. Co-payment for office visits
D. A & B
Answer: A,B
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NO.4 Which of the following statements about the Title VII of the Civil Rights Act is WRONG?
A. Employers with more than 15 employees engaged in interstate commerce need to comply
B. Pregnancy Discrimination Act (an amendment to this act) requires health plans to provide
coverage during childbirth and related medical conditions on the same basis as they provide coverage
for other medical conditions
C. Allows HMOs to set different policies for people from different races, religions, sex or national
origin to safeguard their interests.
D. Protects all employees
Answer: C
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NO.5 Which of the following statements is NOT a requirement for a service to be deemed a
'medically necessary service'?
A. Furnished in the least intensive type of medical care setting required by the member's condition.
B. Solely for the convenience of the member.
C. In accordance with the standards of good medical practice.
D. Consistent with the symptoms of the member's condition.
Answer: B
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NO.6 The Oriole MCO uses a typical diagnosis-related groups (DRGs) payment method to reimburse
the Isle Hospital for its treatment of Oriole members. Under the DRG payment method, whenever an
Oriole member is hospitalized at Isle, Oriole pays Isle
A. an amount based on the weighted value of each medical procedure or service that Isle provides,
and the weighted value is determined by the appropriate current procedural terminology (CPT) code
for the procedure or service
B. a fixed rate based on average expected use of hospital resources in a given geographical area for
that DRG
C. a retrospective reimbursement based on the actual costs of the Oriole member's hospitalization
D. a specific negotiated amount for each day the Oriole member is hospitalized
Answer: B
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NO.7 Which of the choices below contains the four tools used by marketers that make up the
'promotion mix'?
A. Advertising, personal selling, sales promotion, and publicity.
B. Advertising, price, sales promotion, and publicity.
C. Admissions, personal selling, sales promotion, and publicity.
D. Advertising, personal selling, sales promotion, and privacy.
Answer: A
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NO.8 The main purpose of the Health Plan Employer Data and Information Set (HEDIS) is to provide
A. expert consultation to end-users for solving specialized and complex healthcare problems through
the use of a knowledge-based computer system
B. a comprehensive accreditation for PPOs
C. measurements of plan performance and effectiveness that potential healthcare purchasers can use
to compare quality offered by different healthcare plans
D. a mathematical model that can predict future claim payments and premiums
Answer: C
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Exam Code: AHM-250Exam Name: Healthcare Management: An Introduction
One year free update, No help, Full refund!
AHM-250 Test Questions Total Q&A: 367 Questions and Answers
Last Update: 04-21,2015
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