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AHM-510 Exam Dumps : Governance and Regulation

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Governance and Regulation Questions and Answers

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Question 1

While traditional workers' compensation laws have restricted the use of managed care techniques, many states now allow managed workers' compensation. One common characteristic of managed workers' compensation plans is that they

Options:

A.

Discourage injured employees from returning to work until they are able to assume all the duties of their jobs

B.

Use low copayments to encourage employees to choose preferred providers

C.

Cover an employee's medical costs, but they do not provide coverage for lost wages

D.

Rely on total disability management to control indemnity benefits

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Question 2

In examining accountability in the current managed care environment, one is likely to find that combinations of various models of accountability are in operation. Under one model of accountability, the primary mechanisms for accountability are the mechanisms of the marketplace-failure to meet standards will result in a loss of demand for services. By definition, this model of accountability is called the

Options:

A.

Professional model of accountability

B.

Political model of accountability

C.

Due diligence model of accountability

D.

Economic model of accountability

Question 3

Certificate of need (CON) laws apply to health plans in a variety of ways, depending upon the state. By definition, CON laws are laws that are designed to

Options:

A.

Regulate the construction, renovation, and acquisition of healthcare facilities as well as the purchase of major medical equipment in a geographical area

B.

Protect commerce from unlawful restraint of trade, price discrimination, price fixing, reduced competition, and monopolies

C.

Determine benefit payments when a person is covered by more than one plan, such as two group health plans

D.

License and regulate health plans that wish to establish and operate an HMO

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