Free AHM-250 Exam Dumps

Question 11

- (Topic 3)
Which of the following is an example of physician only model of operational integration?

A. Consolidated medical group
B. Integrated Delivery System
C. Medical Foundation
D. Both B & C

Correct Answer:A

Question 12

- (Topic 2)
The Employee Retirement Income Security Act (ERISA) requires health plan members who receive healthcare benefits through employee benefit plans to file legal challenges involving coverage decisions or plan administration at the federal level. Under the te

A. contract damages, which cover the cost of denied treatment
B. compensatory damages, which compensate the injured party for his or her injuries
C. punitive damages, which are designed to punish or make an example of the wrongdoer
D. all of the above

Correct Answer:A

Question 13

- (Topic 3)
Using a code for a procedure or diagnosis that is more complex than the actual procedure or diagnosis and that results in higher reimbursement to the provider is called

A. Coding error
B. Overcharging
C. Upcoming
D. Unbundling

Correct Answer:C

Question 14

- (Topic 3)
Which of the following statements is NOT a requirement for a service to be deemed a 'medically necessary service'?

A. Furnished in the least intensive type of medical care setting required by the member's condition.
B. Solely for the convenience of the member.
C. In accordance with the standards of good medical practice.
D. Consistent with the symptoms of the member's condition.

Correct Answer:B

Question 15

- (Topic 3)
The following statements pertain to the federal requirements for minimum deductible & maximum out of pocket expeses for a high deductible health plan in the year 2006. Select the correct answer from the options given below.

A. Minimum deductible - $ 1,050 for self only coverage ; maximum out of pocket expenses-$ 2,100 for self only coverage
B. Minimum deductible - $ 1,050 for self only coverage ; maximum out of pocket expenses-$ 10.500 for family coverage
C. Minimum deductible - $ 2,100 for self only coverage ; maximum out of pocket expenses-$ 10,500 for self only coverage
D. Minimum deductible - $ 2,100 for self only coverage ; maximum out of pocket expenses-$ 5,250 for self only coverage

Correct Answer:B