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AHM-250 PDF DEMO:
QUESTION NO: 1
One true statement regarding ethics and laws is that the values of a community are reflected in
A. both ethics and laws, and both ethics and laws are enforceable in the court system
B. both ethics and laws, but only laws are enforceable in the court system
C. ethics only, but only laws are enforceable in the court system
D. laws only, but both ethics and laws are enforceable in the court system
Answer: B
QUESTION NO: 2
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
QUESTION NO: 3
Which of the following statements is true?
A. A declining economy can lead to lower healthcare costs as a result of an older population with greater healthcare needs.
B. A larger patient population increases pressure on the health plan to offer larger panels.
C. Provider networks are not affected by the federal and state laws that apply to health plans
D. Network management standards established by independent accrediting organizations have no influence on health plan network design.
Answer: B
QUESTION NO: 4
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
QUESTION 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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Ahm 250 Study Material
Updated: Aug 23, 2019