AHM-250 Exam AI-Powered | Exam-Dumps.net (Page: 6)

QUESTION: 26

Bart Vereen is insured by both a traditional indemnity health insurance plan, which is his primary plan, and a managed care plan. Both plans have a typical coordination of benefits (COB) provision, but neither plan has a nonduplication of benefits provision

380
130
0
550

Answer(s): A

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QUESTION: 27

Because many patients with behavioral health disorders do not require round-the-clock nursing care and supervision, behavioral healthcare services can be delivered effectively in a variety of settings. For example, post-acute care for behavioral health di

Hospital observation units or psychiatric hospitals.
Psychiatric hospitals or rehabilitation hospitals.
Subacute care facilities or skilled nursing facilities.
Psychiatric units in general hospitals or hospital observation units.

Answer(s): C

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QUESTION: 28

Before an HMO contracts with a physician, the HMO first verifies the physician's credentials. Upon becoming part of the HMO's organized system of healthcare, the physician is typically subject to

both recredentialing and peer review
recredentialing only
peer review only
neither recredentialing nor peer review

Answer(s): C

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QUESTION: 29

Before the Hill Health Maintenance Organization (HMO) received a certificate of authority (COA) to operate in State X, it had to meet the state's licensing requirements and financial standards which were established by legislation that is identical to the

Receive compensation based on the volume and variety of medical services they perform for Hill plan members, whereas the specialists receive compensation based solely on the number of plan members who are covered for specific services.
Have no financial incentive to practice preventive care or to focus on improving the health of their plan members, whereas the specialists have a positive incentive to help their plan members stay healthy.
Receive from the IPA the same monthly compensation for each Hill plan member under the PCP's care, whereas the specialists receive compensation based on a percentage discount from their normal fees.
Receive compensation based on a fee schedule, whereas the specialists receive compensation based on per diem charges.

Answer(s): C

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QUESTION: 30

Before the Hill Health Maintenance Organization (HMO) received a certificate of authority (COA) to operate in State X, it had to meet the state's licensing requirements and financial standards which were established by legislation that is identical to the

Hill had to have an initial net worth of at least $1.5 million in order to obtain a CO
The COA most likely exempts Hill from any of State X's enabling statutes.
Hill had to be organized as a partnership in order to obtain a COA
The COA in no way indicates that Hill has demonstrated that it is fiscally sound.

Answer(s): A

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AHIP AHM-250 (page: 6)

QUESTION: 26

QUESTION: 27

QUESTION: 28

QUESTION: 29

QUESTION: 30