AHM-250 Online Practice Questions and Answers

In order to cover some of the gap between FFS Medicare coverage and the actual cost of services, beneficiaries often rely on Medicare supplements. Which of the following statements about Medicare supplements is correct?

A. The initial ten (A-J) Medigap policies offer a basic benefit package that includes coverage for Medicare Part A and Medicare Part B coinsurance.

B. Each insurance company selling Medigap must sell all the different Medigap policies.

C. Medicare SELECT is a Medicare supplement that uses a preferred provider organization (PPO) to supplement Medicare Part A coverage.

D. Medigap benefits vary by plan type (A through L), and are not uniform nationally.

As part of its quality management program, the Lyric Health Plan regularly compares its practices and services with those of its most successful competitor. When Lyric concludes that its competitor's practices or services are better than its own, Lyric im

A. Benchmarking.

B. Standard of care.

C. An adverse event.

D. Case-mix adjustment.

Federal legislation has placed the primary responsibility for regulating health insurance companies and HMOs that service private sector (commercial) plan members at the state level.

This federal legislation is the

A. Clayton Act

B. Federal Trade Commission Act

C. McCarran-Ferguson Act

D. Sherman Act

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

The measures used to evaluate healthcare quality are generally divided into three categories: process, structure, and outcomes. An example of a process measure that can be used to evaluate a health plan's performance is the:

A. Percentage of adult plan members who receive regular medical checkups.

B. Number of plan members contracting an infection in the hospital.

C. Percentage of board certified physicians within the health plan's network.

D. Number of hospital admissions for plan members with certain medical conditions.

Ancillary services are

A. General medical care that is provided directly to a patient without referral from another physician

B. Also known as secondary care (Medical care that is delivered by specialist)

C. Supplemental services needed as part of providing other care

D. Outpatient services provided by a hospital or other qualified ambulatory care facility which require inpatient stay

The following statements apply to flexible spending arrangements. Select the answer choice that contains the correct statement.

A. FSAs were designed to help increase health insurance coverage among self-employed individuals.

B. Only employers may contribute funds to FSAs.

C. The popularity of FSAs has been limited because funds may not be rolled over from year to year.

D. A popular feature of FSAs is their portability, which allows employees to take the funds with them when they change jobs.

Medigap policies were standardized into ten standard benefit pl ranging from A-J by the ____

A. Omnibus Budget Reconciliation Act (OBRA) of 1990

B. Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982

C. Medicare Modernization Act (MMA) of 2003

D. Balanced Budget Act (BBA) of 1997

The following statements are about the underwriting function within a health plan. Select the answer choice containing the correct statement.

A. The underwriting function in a health plan is primarily concerned with ensuring that the group being underwritten does not include any individuals who are likely to have higher than average utilization of medical services.

B. Compared to a health plan with relaxed underwriting requirements, a similar health plan with very strict underwriting requirements can expect to experience increased healthcare costs and to have significantly higher plan enrollment.

C. Typically, a health plan guarantees the premium rate for a group health contract for a period of no more than six months.

D. In order to determine the actual premium to charge a group, a group underwriter typically considers such factors as level of participation, benefits, and the age and gender distribution of group members.

Which of the following best describes an organization that is owned by a hospital or group of investors and provides management and administrative support services to individual physicians or small group practices?

A. Independent Practice Association (IPA).

B. Group Practice Without Walls (GPWW)

C. Management Services Organization (MSO).

D. Consolidated Medical Group.