AHM-250 Free Practice Test

- (Topic 3)
An HMO’s quality assurance program must include

1. A. A statement of the HMO’s goals and objectives for evaluating and improving enrollees’ health status
2. B. Documentation of all quality assurance activities
3. C. System for periodically reporting program results to the HMO’s board of directors, its providers, and regulators
4. D. All the above

Correct Answer: D

- (Topic 2)
Some states mandate that an independent enrollment broker or benefits counselor contractor selected by the state must manage enrollment of the eligible Medicaid population into managed care. In other states a health plan can engage independent brokers and

1. A. Many states have regulations that prohibit health plans from using door-to-door and/or telephone solicitation to market health plan products to the Medicaid population.
2. B. Health plans are never allowed to medically underwrite individual market customers who are under age 65.
3. C. To promote a health plan product to the individual market, health plans typically use captive agents who give sales presentations to potential customers, rather than using promotion tools such as direct mail, telemarketing, or advertising.
4. D. Health plans typically are allowed to medically underwrite all individual market customers who are covered by Medicare and can refuse to cover such customers.

Correct Answer: A

- (Topic 2)
Janet Riva is covered by a indemnity health insurance plan that specifies a $250 deductible and includes a 20% coinsurance provision. When Ms. Riva was hospitalized, she incurred
$2,500 in medical expenses that were covered by her health plan. She incurred

1. A. $1,750
2. B. $1,800
3. C. $2,000
4. D. $2,250

Correct Answer: B

- (Topic 3)
The following statements apply to enrollment statistics for HSAs. Select the answer choice that contains the CORRECT statement.

1. A. HSAs have helped expand health care coverage to consumers who were previously uninsured.
2. B. The vast majority of enrollees in HSA health plans are wealthy.
3. C. Most people receiving coverage through HSA health plans are individuals rather than families.
4. D. HSAs appeal primarily to young consumers.

Correct Answer: A

- (Topic 2)
Patrick Flaherty's employer has contracted to receive healthcare for its employees from the Abundant Healthcare System. Mr. Flaherty visits his primary care physician (PCP), who sends him to have some blood tests. The PCP then refers Mr. Flaherty to a special

1. A. an integrated delivery system (IDS)
2. B. a Management Services Organization (MSO)
3. C. a Physician Practice Management (PPM) company
4. D. a physician-hospital organization (PHO)

Correct Answer: A