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NO.1 The Military Health System of the Department of Defense offers ongoing healthcare coverage
to military personnel and their families through the
A. Health Care Quality Improvement Program (HCQIP)
B. Health Plan Management System (HPMS)
C. TRICARE healthcare system
D. Health Care Prepayment Plan (HCPP)
Answer: C

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NO.2 In response to the demand for a method of assessing outcomes, accrediting organizations and
other government and commercial groups have developed quantitative measures of quality that
consumers, purchasers, regulators, and others can use to compare health
A. quality standards
B. accreditation decisions
C. standards of care
D. performance measures
Answer: D

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NO.3 According to the IRS, which of the following is not an allowable preventive care service?
A. Smoking cessation programs.
B. Periodic health examinations.
C. Health club memberships.
D. Immunizations for children and adults.
Answer: C

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NO.4 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
Answer: B

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NO.5 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.
Answer: B

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NO.6 A public employer, such as a municipality or county government would be considered which of
the following?
A. Employer-employee group
B. Multiple-employer group
C. Affinity group
D. Debtor-creditor group
Answer: A

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NO.7 Bill the member for the balance of the fee above the maximum allowable amount under the fee
schedule reimbursement method
A. UCR fee
B. Capitation fee
C. Balance bill
D. Discounted fee-for-service
Answer: C

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NO.8 The main purpose of the Health Plan Employer Data and Information Set (HEDIS) is to provide
A. expert consultation to end-users for solving specialized and complex healthcare problems through
the use of a knowledge-based computer system
B. a comprehensive accreditation for PPOs
C. measurements of plan performance and effectiveness that potential healthcare purchasers can use
to compare quality offered by different healthcare plans
D. a mathematical model that can predict future claim payments and premiums
Answer: C

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Exam Code: AHM-250
Exam Name: Healthcare Management: An Introduction
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AHM-250 Practice Exam Total Q&A: 367 Questions and Answers
Last Update: 2015-08-27

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Exam Code: AHM-530
Exam Name: Network Management
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AHM-530 Free download Total Q&A: 202 Questions and Answers
Last Update: 2015-08-27

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Posted 2015/8/28 9:59:27  |  Category: AHIP  |  Tag: AHM-250AHM-530 answers real questionsAHIP