AHM-250 Exam Dumps : Healthcare Management: An Introduction

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

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

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

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

Is regulated under federal HMO legislation

Generally provides no benefits for out-of-network care

Has no provider network of physicians

Is not subject to state insurance laws

an evaluation of the medical necessity, efficiency, and/or appropriateness of healthcare services and treatment plans for a given patient

a series of strategies designed to reduce plan members' needs to utilize healthcare services by encouraging preventive care, wellness, member self-care, and appropriate use of healthcare services

a technique that prevents a provider who is being reimbursed under a fee schedule arrangement from billing a plan member for any fees that exceed the maximum fee reimbursed by the plan

a system of identifying plan members with special healthcare needs, developing a healthcare strategy to meet those needs, and coordinating and monitoring the care