AHM-250

AHM-250 practice questions, page 2 of 15, with answer review and explanations.

Question 6

A health savings account must be coupled with an HDHP that meets federal requirements for minimum deductible and maximum out-of-pocket expenses. Dollar amounts are indexed annually for inflation. For 2006, the annual deductible for self-only coverage must

  1. $525
  2. $1,050
  3. $2,100
  4. $5,250

Question 7

A medical foundation is a not-for-profit entity that purchases and manages physician practices. In order to retain its not-for-profit status, a medical foundation must

  1. Provide significant benefit to the community
  2. Employ, rather than contract with, participating physicians
  3. Achieve economies of scale through facility consolidation and practice management
  4. Refrain from the corporate practice of medicine

Question 8

A particular health plan offers a higher level of benefits for services provided in-network than for out-of-network services. This health plan requires preauthorization for certain medical services. With regard to the steps that the health plan's claims enforcement policy, clients:

  1. should assume that all services requiring preauthorization have been preauthorized
  2. should investigate any conflicts between diagnostic codes and treatment codes before approving the claim to ensure that the appropriate payment is made for the claim
  3. need not verify that the provider is part of the health plan's network before approving the claim at the in-network level of benefits
  4. need not determine whether the member is covered by another health plan that allows for coordination of benefits

Question 9

A physician-hospital organization (PHO) may be classified as an open PHO or a closed PHO. With respect to a closed PHO, it is correct to say that

  1. the specialists in the PHO are typically compensated on a capitation basis
  2. the specialists in the PHO are typically compensated on a capitation basis
  3. it typically limits the number of specialists by type of specialty
  4. it is available to a hospital's entire eligible medical staff
  5. physician membership in the PHO is limited to PCPs

Question 10

A public employer, such as a municipality or county government would be considered which of the following?

  1. Employer-employee group
  2. Multiple-employer group
  3. Affinity group
  4. Debtor-creditor group