Free AHM-250 Exam Dumps

Question 51

- (Topic 3)
The following statements are about concepts related to the underwriting function within a health plan. Select the answer choice containing the correct statement.

A. Anti selection refers to the fact that individuals who believe that they have a less-than-
B. average likelihood of loss tend to seek healthcare coverage to a greater extent than do individuals who believe that they have an average or greater-than-average like
C. Federally qualified HMOs are required to medically underwrite all groups applying for coverage.
D. Typically, a health plan guarantees the premium rate for a group health contract for a period of five years.
E. When evaluating the risk for a group policy, underwriters typically focus on such factors as the size of the group, the stability of the group, and the activities of the group.

Correct Answer:D

Question 52

- (Topic 1)
In addition to the credentialing activities that an health plan performs when initially accepting a provider into its network, the health plan must also perform recredentialing of the same providers on an ongoing basis. Many of the same activities are per

A. verification of a network provider's medical education and residency
B. performance of site inspections in a provider's facilities
C. review of information from a provider's quality improvement activities
D. verification of a provider's licensure and certification

Correct Answer:A

Question 53

- (Topic 2)
The following programs are part of the Alcove MCO's utilization management (UM) program:
✑ A telephone triage program
✑ Preventive care initiatives
✑ A shared decision-making program
✑ A self-care program
With regard to the UM programs, it is most likely cor

A. self-care program is intended to complement physicians' services, rather than to supercede or eliminate these services
B. telephone triage program is staffed by physicians only
C. shared decision-making program is appropriate for virtually any medical condition
D. preventive care initiatives include immunization programs but not health promotion programs

Correct Answer:A

Question 54

- (Topic 3)
The process of calculating the appropriate premium to charge purchasers, given the degree of risk represented by the individual or group, the expected costs to deliver medical services, and the expected marketability and competitiveness of the health plan

A. financing
B. rating
C. underwriting
D. budgeting

Correct Answer:B

Question 55

- (Topic 2)
The data evaluation stage of utilization review (UR) includes both administrative reviews and medical reviews. One true statement about these types of reviews is that:

A. An administrative review must be conducted by a health plan staff member who is a medical professional.
B. The primary purpose of an administrative review is to evaluate the appropriateness of a proposed medical service.
C. UR staff members typically conduct a medical review of a proposed medical service before they conduct an administrative review for that same service.
D. One purpose of a medical review is to evaluate the medical necessity of a proposed medical service.

Correct Answer:D