Free AHM-250 Exam Dumps

Question 21

- (Topic 3)
When the Knoll Company purchased group health coverage from the Castle Health Maintenance Organization (HMO), the agreement between the two parties specified that the plan would be a typical fully funded plan. Because Knoll had been covered under a
previo

A. Castle is responsible for paying for all incurred covered benefits
B. Knoll is solely responsible for guaranteeing claim payments
C. Knoll makes no premium payments to Castle
D. Castle has no responsibilities for administering the health plan

Correct Answer:A

Question 22

- (Topic 2)
Paul Gilbert has been covered by a group health plan for two years. He has been undergoing treatment for angina for the past three months. Last week, Mr. Gilbert began a new job and immediately enrolled in his new company's group health plan, which has a

A. Can exclude coverage for treatment of M
B. Gilbert's angina for one year, because HIPAA does not impact a group health plan's pre-existing condition provision.
C. Can exclude coverage for treatment of M
D. Gilbert's angina for one year, because M
E. Gilbert did not have at least 36 months of creditable coverage under his previous health plan.
F. Can exclude coverage for treatment of M
G. Gilbert's angina for three months, because that is the length of time he received treatment for this medical condition prior to his enrollment in the new health plan.
H. Cannot exclude his angina as a pre-existing condition, because the one-year pre- existing condition provision is offset by at least one year of continuous coverage under his previous health plan.

Correct Answer:D

Question 23

- (Topic 2)
The Fairway Health Group contracted with the Empire Corporation to provide behavioral healthcare services to Empire employees. As a condition of providing behavioral healthcare services, Fairway required Empire to contract with Fairway for basic medical s

A. horizontal group boycott
B. price-fixing agreement
C. horizontal division of markets
D. tying arrangement

Correct Answer:D

Question 24

- (Topic 3)
The Oriole MCO uses a typical diagnosis-related groups (DRGs) payment method to reimburse the Isle Hospital for its treatment of Oriole members. Under the DRG payment method, whenever an Oriole member is hospitalized at Isle, Oriole pays Isle

A. an amount based on the weighted value of each medical procedure or service that Isle provides, and the weighted value is determined by the appropriate current procedural terminology (CPT) code for the procedure or service
B. a fixed rate based on average expected use of hospital resources in a given geographical area for that DRG
C. a retrospective reimbursement based on the actual costs of the Oriole member's hospitalization
D. a specific negotiated amount for each day the Oriole member is hospitalized

Correct Answer:B

Question 25

- (Topic 2)
The Cleopatra Group, a third-party administrator (TPA), has entered into a TPA agreement with the Alexander MCO with regard to the administration of a particular health plan. This agreement complies with all of the provisions of the NAIC TPA Model Law. On

A. hold all funds it receives on behalf of Alexander in trust
B. assume full responsibility for determining the claim payment procedures for the plan
C. assume full responsibility for ensuring that the health plan is administered properly
D. obtain from the federal government a certificate of authority designating the Cleopatra Group as a TPA

Correct Answer:A