Pass the AHIP AHIP Certification AHM-250 Questions and answers with CertsForce

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Viewing questions 81-90 out of questions
Questions # 81:

The Venus Hospital provides medical care to paying patients, as well as to people who either have no healthcare coverage and cannot pay for the care by themselves or who receive services at reduced rates because they are covered under government sponsored

Options:

A.

anti selection


B.

cost shifting


C.

receivership


D.

underwriting


Expert Solution
Questions # 82:

Which of the following statements about Family and Medical Leave Act (FMLA) is WRONG?

Options:

A.

Employers need to maintain the coverage of group health insurance during this period


B.

Employees can take upto 12 weeks of unpaid leave in a 36 month period


C.

Protects people faced with birth/adoption or seriously ill family members


D.

Employers that have > 50 employees need to comply


Expert Solution
Questions # 83:

The Polestar Company's sole business is the ownership of Polaris Medical Group, a health plan and subsidiary of Polestar. Some members of Polestar's board of directors hold positions with Polestar in addition to their positions on the board; the rest are

Options:

A.

Polestar's relationship to Polaris: partnership

Type of board member: operations director


B.

Polestar's relationship to Polaris: partnership

Type of board member: outside director


C.

Polestar's relationship to Polaris: holding company

Type of board member: operations director


D.

Polestar's relationship to Polaris: holding company

Type of board member: outside director


Expert Solution
Questions # 84:

Which of the following is NOT a preventive care initiative often used by health plans?

Options:

A.

Screening for high blood pressure


B.

Maternity management programs


C.

Vaccines


D.

Physical therapy


Expert Solution
Questions # 85:

Which out of the three is accomplished through precertification?

Options:

A.

Concurrent review


B.

Retrospective review


C.

Prospective review


Expert Solution
Questions # 86:

Which of the choices below contains the four tools used by marketers that make up the 'promotion mix'?

Options:

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.


Expert Solution
Questions # 87:

The Mirror Health Plan uses a form of computer/telephony integration (CTI) to manage telephone calls coming into its member services department. When a member calls the plan's central telephone number, a device answers the call with a recorded message and

Options:

A.

a member outreach program


B.

a complaint resolution procedure (CRP)


C.

an automatic call distributor (ACD)


D.

an interactive voice response (IVR) system


Expert Solution
Questions # 88:

Which of the following is(are) CORRECT?

(A) Staff model HMOs can achieve maximum economies of scale but are heavily capital intensive.

(B) Staff model HMOs are closed panel.

(C) Staff model HMOs operate out of ambulatory care facilities.

Options:

A.

A & B


B.

None of the listed options


C.

B & C


D.

All of the listed options


Expert Solution
Questions # 89:

Which of the following is CORRECT?

Options:

A.

Electronic transmittal of authorization is subject to the same regulatory requirements as other methods of transmittal


B.

Telephone transmittal increases data entry errors.


C.

Medical review is conducted before administrative review.


D.

Prospective review, concurrent review and retrospective review are types of utilization review


Expert Solution
Questions # 90:

The following statements are about the make-up and function of an HMO's board of directors.

Select the answer choice that contains the correct statement.

Options:

A.

The make-up of an HMO's board of directors is prescribed by state regulations and does not vary according to whether the plan is a for-profit or not-for-profit plan.


B.

The board of directors of a not-for-profit HMO is exempt from liability for its actions.


C.

An HMO's board of directors is not responsible for supervising the performance of its officers and outside advisors.


D.

A primary function of the board of directors is to approve and evaluate the organization's operational policies and procedures.


Expert Solution
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