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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

During the risk assessment process for a traditional indemnity group insurance health plan, group underwriters consider such characteristics as a group’s geographic location, the size and gender mix of the group, and the level of participation in the grou

Options:

A.

Healthcare costs are typically higher in rural areas than in large urban areas.

B.

The morbidity rate for males is higher than the morbidity rate for females.

C.

The larger the group, the more likely it is that the group will experience losses similar to the average rate of loss that was predicted.

D.

All of the above

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Question 2

The contract between the Honolulu MCO and Beverley Hills Hospital contains a 90 day cure provision. The Beverley Hills Hospital breached one of the contract requirements on July 31, 2004. The hospital remedied the problem by October 31, 2004. Which of the

Options:

A.

The contract would not be terminated as Beverley Hills hospital rectified the problem within 90 days.

B.

The contract would be terminated as Beverley Hills hospital was required to notify Honolulu MCO about the problem at least 90 days in advance.

C.

The contract would be terminated as Beverley Hills hospital was required to rectify the problem within 90 days.

D.

The contract would not be terminated as Beverley Hills hospital may escape adherence to the cure provision.

Question 3

If left unresolved, member complaints about the actions or decisions made by a health plan or its providers can lead to formal appeals. One procedure health plans can use to address formal appeals is to submit the original decision and any supporting info

Options:

A.

A Level One appeal, and the member has the right to a further appeal

B.

A Level Two appeal, and the reviewer's decision is final and binding

C.

An independent external appeal, and the member has the right to a further appeal

D.

Arbitration, and the reviewer's decision is final and binding