Free AHM-250 Exam Braindumps

- (Topic 3)
The Robust Health Plan sometimes uses prospective experience rating to calculate the premiums for a group. Under prospective experience rating, Robust most likely will:

1. A. At the end of a rating period, the financial gains and losses experienced by the group during that rating period and, if the group's experience during the period is better than expected, refund part of the group's premium in the form of an experience ratio
2. B. Use Robust's average experience with all groups to calculate this particular group's premium.
3. C. Use the group's past experience to estimate the group's expected experience for the next period.
4. D. All of the above

Correct Answer: C

- (Topic 3)
Graff Scott is a member of the ABC Health Plan. Whenever she needs non-emergency medical care, sees Dr. Michael Chan, an internist. Ms. Scott cannot self-refer to a specialist, so she saw Dr. Michael Chan when she experienced headaches. Dr. Michael Chan referred her to Dr. Bruce Lee, a neurologist, who had hospitalized at the Polo Hospital for tests. ABC has contracts with Dr. Michael Chan, Dr. Lee, and Polo to provide medical services to its members. The following statements are about Polo's organized system of healthcare. Select the answer choice containing the correct statement

1. A. Within Polo's system, M
2. B. Scott received primary care from both D
3. C. Michael Chan and D
4. D. Lee
5. E. Polo's system allows its members open access to all of Ultra's participating providers
6. F. Polo's network of providers includes D
7. G. Michael Chan and D
8. H. Lee but not Polo Hospital
9. I. Within Polo's system, D
10. J. Michael Chan serves as a coordinator of care or gatekeeper for the medical services that M
11. K. Scott receives

Correct Answer: D

- (Topic 2)
In the United States, the Department of Defense offers ongoing healthcare coverage to military personnel and their families through the TRICARE health plan. One true statement about TRICARE is that

1. A. hospitals participating in TRICARE program are exempt from JCAHO accreditation and Medicare certification
2. B. TRICARE enrollees are not entitled to appeal authorization coverage decisions
3. C. active duty personnel are automatically considered enrolled in TRICARE Prime
4. D. TRICARE covers inpatient and outpatient services, physician and hospital charges, and medical supplies, but not mental health services

Correct Answer: C

- (Topic 3)
The National Association of Insurance Commissioners (NAIC) developed the Small Group Model Act to enable small groups to obtain accessible, yet affordable, group health benefits. The model law limits the rate spread, which is the difference between the highest and lowest rates that a health plan charges small groups, to a particular ratio.
According to the Model Act, for example, if the lowest rate an HMO charges a small group for a given set of medical benefits is $40, then the maximum rate the HMO can charge for the same set of benefits is

1. A. $60
2. B. $80
3. C. $120
4. D. $160

Correct Answer: B

- (Topic 3)
Types of alternative care centers include urgent care centers, observation care units, and stepdown units. One difference between the costs associated with alternative care centers is that, compared to the cost of:

1. A. Facilities, equipment, and staffing in hospital emergency departments (EDs), the cost of facilities, equipment, and staffing in observation care units is generally lower
2. B. Care delivered in urgent care centers, the cost of care delivered in hospital emergency departments (EDs) is generally lower.
3. C. Care in step-down units, the cost of acute inpatient care is generally lower.
4. D. Primary care in a physician's office, the cost of care delivered in urgent care centers is generally lower.

Correct Answer: A