AHIP Certification AHM-250 AHIP Study Notes

Healthcare Management: An Introduction Questions and Answers

Question 17

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:

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

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

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

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

Question 18

Amendments to the HMO act 1973 do not permit federally qualified HMO’s to use

Options:

Retrospective experience rating

Adjusted community rating

Community rating by class

Community rating

Question 19

If left unresolved, member complaints about the actions or decisions made by a health plan or its providers can lead to formal appeals. One procedure health plans can use to address formal appeals is to submit the original decision and any supporting info

Options:

A Level One appeal, and the member has the right to a further appeal

A Level Two appeal, and the reviewer's decision is final and binding

An independent external appeal, and the member has the right to a further appeal

Arbitration, and the reviewer's decision is final and binding

Question 20

Primary care case managers (PCCMs) provide managed healthcare services to eligible Medicaid recipients. With regard to PCCMs, it is correct to say that

Options:

PCCMs contract directly with the federal government to provide case management services to Medicaid recipients

all Medicaid recipients who live in rural areas must be given a choice of at least four PCCMs

Medicaid PCCM programs are exempt from the Health Care Financing Administration's (HCFA's) Quality Improvement System for Managed Care (QISMC) standards

PCCMs typically receive a case management fee, rather than reimbursement for medical services on a FFS basis, for the services they provide to Medicaid recipients

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AHIP Certification AHM-250 AHIP Study Notes

Healthcare Management: An Introduction Questions and Answers

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CompTIA

Fortinet

Microsoft

Salesforce