Free AHM-250 Exam Braindumps

- (Topic 3)
The Neptune Hospital provides medical care to paying patients, as well as to people who either have no healthcare coverage and cannot afford to pay for the care by themselves or who receive services at reduced rates because they are covered under govern me

1. A. cost shifting
2. B. Anti selection
3. C. receivership
4. D. Underwriting

Correct Answer: A

- (Topic 1)
Col. Martin Avery, on active duty in the U.S. Army, iseligibleto receive healthcare benefits under one of the three TRICARE health plan options. If Col Avery elects to participate in TRICARE Prime, he will be

1. A. able to obtain full benefits for services obtained from network and non-network providers
2. B. subject to copayment, deductible, and coinsurance requirements for any medical care he receives
3. C. required to formally enroll for coverage and pay an enrollment fee
4. D. assigned to a primary care manager who is responsible for coordinating all his care

Correct Answer: D

- (Topic 2)
Many of the credentialing standards and criteria used by health plans are often taken from already existing standards established by

1. A. the National Practitioner Data Bank (NPDB)
2. B. the National Association of Insurance Commissioners (NAIC)
3. C. the Centers for Medicare and Medicaid Services (CMS)
4. D. independent accrediting organizations

Correct Answer: D

- (Topic 3)
The National Committee for Quality Assurance (NCQA) is a nonprofit organization that accredits health plans and other healthcare organizations. Under the current NCQA accreditation program, a health plan's accreditation score is determined, in part, by pe

1. A. is a performance-measurement tool designed to help healthcare purchasers and consumers compare quality offered by different plans.
2. B. divides performance measures into 8 domains, and organizes reporting measures under these domains.
3. C. is updated annually and measures are changed or new measures added.
4. D. all of the above

Correct Answer: D

- (Topic 3)
The Houston Company, a United States company, offers its eligible employees health insurance coverage through a group health plan. Houston hired the Dallas Company to handle the plan's claim administration and membership services, but Houston is financial

1. A. Houston is required to purchase stop-loss insurance to cover its losses under this group health plan
2. B. Houston's plan is a self-funded plan
3. C. Dallas is the plan's sponsor
4. D. Houston's plan is not exempt from any state insurance regulations under ERISA

Correct Answer: B