Free AHM-250 Exam Braindumps

- (Topic 3)
The Gable MCO sometimes experience-rates small groups by underwriting a number of small groups as if they constituted one large group and then evaluating the experience of
the entire large group. This practice, which allows small groups to take advantage

1. A. prospective experience rating
2. B. pooling
3. C. retrospective experience rating
4. D. positioning

Correct Answer: B

- (Topic 1)
Ed Murray is a claims analyst for a managed care plan that provides a higher level of benefits for services received in-network than for services received out-of-network. Whenever Mr. Murray receives a health claim from a plan member, he reviews the claim

1. A. A, B, C, and D
2. B. A and C only
3. C. A, B, and D only
4. D. B, C, and D only

Correct Answer: A

- (Topic 2)
One true statement regarding ethics and laws is that the values of a community are reflected in

1. A. both ethics and laws, and both ethics and laws are enforceable in the court system
2. B. both ethics and laws, but only laws are enforceable in the court system
3. C. ethics only, but only laws are enforceable in the court system
4. D. laws only, but both ethics and laws are enforceable in the court system

Correct Answer: B

- (Topic 2)
Specialty services that have certain characteristics generally are good candidates for managed care approaches. These characteristics generally include that the specialty service should have

1. A. appropriate, rather than inappropriate, utilization
2. B. a defined patient population
3. C. low, stable costs
4. D. a benefit that cannot be easily defined

Correct Answer: B

- (Topic 3)
FSA is funded by

1. A. Employers
2. B. Employee
3. C. A & B

Correct Answer: AB