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

Question 1

The Panacea Healthcare System is a single large medical practice based in Oakland, California. The physicians of Panacea operate through a single office located in the Beverly Hills region of Oakland & do have access to the same medical records. Panacea is owned by Queen's hospital & before Panacea acquired the practices of its participating physicians, these physicians were independent practitioners. Which of the following terms best describes Panacea?

A. None of the above

B. Consolidated Medical Group

C. Physician Practice Management Compare

D. Physician Hospital Organization

Correct Answer: B

Question 2

Prescription drug benefits in Medicare can be obtained through:

A. Both A & C

B. Medicare Advantage pl

C. Stand alone prescription drug pl (PDPs)

D. Traditional fee for service (FFS) Medicare

Correct Answer: C

Question 3

If a state commissioner of insurance places an HMO under administrative supervision, then the purpose of this action most likely is to:

A. Sell the HMO's assets in order to satisfy the HMO's obligations.

B. Allow the state commissioner, acting for a state court, to take control of and administer the HMO's assets and liabilities.

C. Place the HMO's operations under the direction and control of the state commissioner or a person appointed by the commissioner.

D. Transfer all of the HMO's business to other carriers.

Correct Answer: C

Question 4

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

A. All accrediting organizations use the same standards of accreditation.

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

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

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

Correct Answer: C

Question 5

Khalyn Drury's employer includes managed dental care in its employee benefits package. During open enrollment, Ms. Drury enrolled in the dental plan, which provides dental services to its members in exchange for a prepayment (the premium). Dental services

A. dental preferred provider organization (PPO)

B. dental health maintenance organization (DHMO)

C. plan with a dental point of service (POS) option

D. traditional fee-for-service (FFS) dental plan

Correct Answer: B

Question 6

Arthur Moyer is covered under his employer's group health plan, which must comply with the Consolidated Omnibus Budget Reconciliation Act (COBRA). Mr. Moyer is terminating his employment. He has elected to continue his coverage under his employer's group

A. 36 months, even if he obtains group health coverage through another employer.

B. 36 months, but his coverage under COBRA will cease if he obtains group health coverage through another employer.

C. 18 months, even if he obtains group health coverage through another employer.

D. 18 months, but his coverage under COBRA will cease if he obtains group health coverage through another employer.

Correct Answer: D

Question 7

One way in which a health plan can support an ethical environment is by

A. establishing a formal method of managing ethical conflicts, such as using an ethics task force or bioethics consultant

B. requiring organizations with which it contracts to adopt the plan's formal ethical policy

C. developing and maintaining a culture where ethical considerations are integrated into decision making at the top organizational level only

D. maintaining control of policy development by removing providers and members from the process of developing and implementing policies and procedures that provide guidance to providers and members confronted with ethical issues

Correct Answer: A

Question 8

Bill Clinton is a member of Lewinsky's PBM plan which has a three-tier copayment structure. Bill fell ill and his doctor prescribed him AAA, a brand-name drug which was included in the Lewinsky's formulary; BBB, a non-formulary drug; and CCC, a generic dr

A. CCC, AAA, BBB

B. BBB, CCC, AAA

C. BBB, AAA, CCC

D. CCC, BBB, AAA

Correct Answer: A

Question 9

In assessing the potential degree of risk represented by a proposed insured, a health underwriter considers the factor of anti selection. Anti selection can correctly be defined as the

A. inability of a proposed insured to share with the insurer the financial risks of healthcare coverage

B. possibility that a proposed insured will profit from an illness by receiving benefits that exceed the total amount of his or her eligible medical expenses

C. tendency of people who have a greater-than-average likelihood of loss to apply for or continue insurance protection to a greater extent than people who have an average or less than average likelihood of the same loss

D. inability of a proposed insured to provide sufficient evidence that proves he or she is an insurable risk

Correct Answer: C

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

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