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AHM-250 Exam Dumps : Healthcare Management: An Introduction

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Healthcare Management: An Introduction Questions and Answers

Question 1

From the following choices, choose the definition that best matches the term Screening

Options:

A.

A technique used to educate plan members on how to distinguish between minor problems and serious conditions and effectively treat minor problems themselves

B.

A technique used to determine if a health condition is present even if a member has not experienced symptoms of the problem

C.

A technique in which information about a plan member's health status, personal and family health history, and health-related behaviors is used to predict the member's likelihood of experiencing specific illnesses or injuries

D.

A technique used to evaluate the medical necessity, appropriateness, and cost-effectiveness of healthcare services for a given patient

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Question 2

In health plan terminology, demand management, as used by health plans, can best be described as

Options:

A.

an evaluation of the medical necessity, efficiency, and/or appropriateness of healthcare services and treatment plans for a given patient

B.

a series of strategies designed to reduce plan members' needs to utilize healthcare services by encouraging preventive care, wellness, member self-care, and appropriate use of healthcare services

C.

a technique that prevents a provider who is being reimbursed under a fee schedule arrangement from billing a plan member for any fees that exceed the maximum fee reimbursed by the plan

D.

a system of identifying plan members with special healthcare needs, developing a healthcare strategy to meet those needs, and coordinating and monitoring the care

Question 3

In order to cover some of the gap between FFS Medicare coverage and the actual cost of services, beneficiaries often rely on Medicare supplements. Which of the following statements about Medicare supplements is correct?

Options:

A.

The initial ten (A-J) Medigap policies offer a basic benefit package that includes coverage for Medicare Part A and Medicare Part B coinsurance.

B.

Each insurance company selling Medigap must sell all the different Medigap policies.

C.

Medicare SELECT is a Medicare supplement that uses a preferred provider organization (PPO) to supplement Medicare Part A coverage.

D.

Medigap benefits vary by plan type (A through L), and are not uniform nationally.