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Ace the AHIP AHM-250 Exam: Ultimate Preparation Guide

Questions 71

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?

Options:

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.

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Questions 72

Identify the CORRECT statement(s):

(A) Smaller the group, the more likely it is that the group will experience losses similar to the average rate of loss that was predicted.

(B) Gender of the group's participants has no effect on the likelihood of loss.

Options:

A.

All of the listed options

B.

B & C

C.

None of the listed options

D.

A & C

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Questions 73

From the following choices, choose the definition that best matches the term Screening

Options:

A.

A technique used to educate plan members on how to distinguish between minor problems and serious conditions and effectively treat minor problems themselves

B.

A technique used to determine if a health condition is present even if a member has not experienced symptoms of the problem

C.

A technique in which information about a plan member's health status, personal and family health history, and health-related behaviors is used to predict the member's likelihood of experiencing specific illnesses or injuries

D.

A technique used to evaluate the medical necessity, appropriateness, and cost-effectiveness of healthcare services for a given patient

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Questions 74

Dr. Samuel Aldridge's provider contract with the Badger Health Plan includes a typical due process clause. The primary purpose of this clause is to:

Options:

A.

State that Dr. Aldridge's provider contract with Badger will automatically terminate if he loses his medical license or hospital privileges.

B.

Specify a time period during which the party that breaches the provider contract must remedy the problem in order to avoid termination of the contract.

C.

Give Dr. Aldridge the right to appeal Badger's decision if he is terminated with cause from Badger's provider network.

D.

Specify that Badger can terminate this provider contract without providing a reason, but only if Badger gives Dr. Aldridge at least 90-days' notice of its intent to terminate the contract.

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Questions 75

A public employer, such as a municipality or county government would be considered which of the following?

Options:

A.

Employer-employee group

B.

Multiple-employer group

C.

Affinity group

D.

Debtor-creditor group

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Questions 76

A medical foundation is a not-for-profit entity that purchases and manages physician practices. In order to retain its not-for-profit status, a medical foundation must

Options:

A.

Provide significant benefit to the community

B.

Employ, rather than contract with, participating physicians

C.

Achieve economies of scale through facility consolidation and practice management

D.

Refrain from the corporate practice of medicine

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Questions 77

In accounting terminology, the items of value that a company owns—such as cash, cash equivalents, and receivables—are generally known as the company's

Options:

A.

revenue

B.

net income

C.

surplus

D.

assets

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Questions 78

From the following choices, choose the definition that best matches the term health risk assessment (HRA)

Options:

A.

A technique used to educate plan members on how to distinguish between minor problems and serious conditions and effectively treat minor problems themselves

B.

A technique used to determine if a health condition is present even if a member has not experienced symptoms of the problem

C.

A technique in which information about a plan member's health status, personal and family health history, and health-related behaviors is used to predict the member's likelihood of experiencing specific illnesses or injuries

D.

A technique used to evaluate the medical necessity, appropriateness, and cost-effectiveness of healthcare services for a given patient

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Questions 79

During an open enrollment period in 1997, Amy Hadek enrolled through her employer for group health coverage with the Owl Health Plan, a federally qualified HMO. At the time of her enrollment, Ms. Hadek had three pre-existing medical conditions: angina, fo

Options:

A.

the angina, the high blood pressure, and the broken ankle

B.

the angina and the high blood pressure only

C.

none of these conditions

D.

the broken ankle only

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Questions 80

In order to generate exchanges with consumers, healthcare plan marketers use the four elements of the marketing mix: product, price, place (distribution), and

Options:

A.

segmentation

B.

publicity

C.

promotion

D.

plan design

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