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AHM-250 Exam Dumps : Healthcare Management: An Introduction

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Healthcare Management: An Introduction Questions and Answers

Question 1

PBM plans operate under several types of contractual arrangements. Under one contractual arrangement, the PBM plan and the employer agree on a target cost per employee per month. If the actual cost per employee per month is greater than the target cost, t

Options:

A.

fee-for-service arrangement

B.

risk sharing contract

C.

capitation contract

D.

rebate contract

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Question 2

Medicaid is a jointly funded federal and state program that provides hospital and medical expense coverage to low-income individuals and certain aged and disabled individuals. One characteristic of Medicaid is that

Options:

A.

providers who care for Medicaid recipients must accept Medicaid payment as payment in full for services rendered

B.

Medicaid requires recipients to pay deductibles, copayments, and coinsurance amounts for all services

C.

Medicaid is always the primary payer of benefits

D.

benefits offered by Medicaid programs are federally mandated and do not vary by state

Question 3

The National Association of Insurance Commissioners' (NAIC's) Unfair Claims Settlement Practices Act specifies standards for the investigation and handling of claims. The Act defines unfair claims practices and notes that such practices are improper if the

Options:

A.

Both A and B

B.

A only

C.

B only

D.

Neither A nor B