Online Access Free AHM-250 Exam Questions

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, and D only
• B.A and C only
• C.B, C, and D only
• D.A, B, C, and D

Some states mandate that an independent enrollment broker or benefits counselor contractor selected by the state must manage enrollment of the eligible Medicaid population into managed care. In other states a health plan can engage independent brokers and

• A.Health plans typically are allowed to medically underwrite all individual market customers who are covered by Medicare and can refuse to cover such customers.
• B.Many states have regulations that prohibit health plans from using door-to-door and/or telephone solicitation to market health plan products to the Medicaid population.
• C.Health plans are never allowed to medically underwrite individual market customers who are under age 65.
• D.To promote a health plan product to the individual market, health plans typically use captive agents who give sales presentations to potential customers, rather than using promotion tools such as direct mail, telemarketing, or advertising.

One ethical principle in health plans is the principle of non-malfeasance, which holds that health plans and their providers:

• A.Should treat each plan member in a manner that respects his or her goals and values.
• B.Are obligated not to harm their members.
• C.Have a duty to present information honestly and are obligated to honor commitments.
• D.Should allocate resources in a way that fairly distributes benefits and burdens among the members.

Health plans' use of the Internet to provide plan members with health-related information has grown rapidly in recent years. One advantage the Internet has over other forms of communication is that

• A.users can access the Internet using a number of different types of computer systems
• B.access to the Internet is available only to members of the health plan's network
• C.users can contact a single controlling organization to rectify disruptions in Internet service
• D.the Internet is immune to internal security breaches by employees or trading partners within the network

The prudent layperson standard described in the Balanced Budget Act (BBA) of 1997 requires all hospitals that receive Medicare or Medicaid reimbursement to screen and, if necessary, stabilize all patients who come to their emergency departments.

• A.True
• B.False