Exactprep AHM-250 Questions

Healthcare Management: An Introduction Questions and Answers

Question 21

The Courtland PPO maintains computerized records that include clinical, demographic, and administrative data about individual plan members. The data in these records is available to plan providers, ancillary service departments, pharmacies, and others inv

Options:

a data warehouse

a decision support system

an outsourcing system

an electronic medical record (EMR) system

Question 22

Paul Gilbert has been covered by a group health plan for two years. He has been undergoing treatment for angina for the past three months. Last week, Mr. Gilbert began a new job and immediately enrolled in his new company's group health plan, which has a

Options:

Can exclude coverage for treatment of Mr. Gilbert's angina for one year, because HIPAA does not impact a group health plan's pre-existing condition provision.

Can exclude coverage for treatment of Mr. Gilbert's angina for one year, because Mr. Gilbert did not have at least 36 months of creditable coverage under his previous health plan.

Can exclude coverage for treatment of Mr. Gilbert's angina for three months, because that is the length of time he received treatment for this medical condition prior to his enrollment in the new health plan.

Cannot exclude his angina as a pre-existing condition, because the one-year pre-existing condition provision is offset by at least one year of continuous coverage under his previous health plan.

Question 23

One type of physician-only integration model is a consolidated medical group. Typical characteristics of a consolidated medical group include

Options:

that it may be a single-specialty or multi-specialty practice

operates in one or a few facilities rather than in many independent offices

achieves economies of scale in the group's integrated operations

all of the above

Question 24

Many of the credentialing standards and criteria used by health plans are often taken from already existing standards established by

Options:

the National Practitioner Data Bank (NPDB)

the National Association of Insurance Commissioners (NAIC)

the Centers for Medicare and Medicaid Services (CMS)

independent accrediting organizations

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Healthcare Management: An Introduction Questions and Answers

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