AHM-250 Free Practice Test

- (Topic 3)
The statements below describe technology used by two MCOs to respond to incoming telephone calls:
✑ The Morton MCO uses an automated system that answers telephone calls with recorded or synthesized speech and prompts the caller to respond to a menu of opt

1. A. Autumn's device is best described as an interactive voice response (IVR) system.
2. B. Both Morton's system and Autumn's device are applications of computer/telephony
3. C. integration (CTI).
4. D. Morton's system is best described as an automatic call distributor (ACD).
5. E. Morton's system can be correctly characterized as an expert system.

Correct Answer: B

- (Topic 3)
The following statements are about the non-group market for managed care products in the United States. Select the answer choice containing the correct statement.

1. A. In order to promote a product to the individual market, MCOs typically rely on personal selling by captive agents rather than on promotional tools such as direct mail, telemarketing, and advertising.
2. B. Managed Medicare plans typically are allowed to reject a Medicare applicant on the basis of the results of medical underwriting of the applicant.
3. C. HCFA (now known as the Centers for Medicare and Medicaid Services) must approve all membership and enrollment materials used by MCOs to market managed care products to the Medicare population.
4. D. Managed care plans are not allowed to health screen individual market customers who are under age 65, even if the health screen could help prevent anti selection.

Correct Answer: C

- (Topic 3)
When the Knoll Company purchased group health coverage from the Castle Health Maintenance Organization (HMO), the agreement between the two parties specified that the plan would be a typical fully funded plan. Because Knoll had been covered under a
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1. A. Castle is responsible for paying for all incurred covered benefits
2. B. Knoll is solely responsible for guaranteeing claim payments
3. C. Knoll makes no premium payments to Castle
4. D. Castle has no responsibilities for administering the health plan

Correct Answer: A

- (Topic 2)
The Employee Retirement Income Security Act (ERISA) requires health plan members who receive healthcare benefits through employee benefit plans to file legal challenges involving coverage decisions or plan administration at the federal level. Under the te

1. A. contract damages, which cover the cost of denied treatment
2. B. compensatory damages, which compensate the injured party for his or her injuries
3. C. punitive damages, which are designed to punish or make an example of the wrongdoer
4. D. all of the above

Correct Answer: A

- (Topic 1)
Dr. Julia Phram is a cardiologist under contract to Holcomb HMO, Inc., a typical closed- panel plan. The following statements are about this situation. Select the answer choice containing the correct statement.

1. A. All members of Holcomb HMO must select D
2. B. Phram as their primary care physician (PCP).
3. C. Any physician who meets Holcomb's standards of care is eligible to contract with Holcomb HMO as a provider.
4. D. D
5. E. Phram is either an employee of Holcomb HMO or belongs to a group of physicians that has contracted with Holcomb HMO
6. F. Holcomb HMO plan members may self-refer to D
7. G. Phram at full benefits without first obtaining a referral from their PCPs.

Correct Answer: A