AHM-250 practice questions, page 5 of 15, with answer review and explanations.
Question 21
Arthur Moyer is covered under his employer's group health plan, which must comply with the Consolidated Omnibus Budget Reconciliation Act (COBRA). Mr. Moyer is terminating his employment. He has elected to continue his coverage under his employer's group
18 months, but his coverage under COBRA will cease if he obtains group health coverage through another employer.
18 months, even if he obtains group health coverage through another employer.
36 months, but his coverage under COBRA will cease if he obtains group health coverage through another employer.
36 months, even if he obtains group health coverage through another employer.
Question 22
As part of its quality management program, the Lyric Health Plan regularly compares its practices and services with those of its most successful competitor. When Lyric concludes that its competitor's practices or services are better than its own, Lyric imports these policies and procedures for themselves. What is this called?
Benchmarking.
Standard of care.
An adverse event.
Case-mix adjustment.
Question 23
As part of its utilization management (UM) system, the Creole Health Plan uses a process known as case management. The following individuals are members of the Creole Health Plan: -Jill Novacek, who has a chronic respiratory condition. -Abraham Rashad.
Ms. Novacek, Mr. Rashad, and Mr. DevereauxB. Ms. Novacek and Mr. Rashad only
Ms. Novacek and Mr. Devereaux only
None of these members
Question 24
As part of its utilization management (UM) system, the Poplar MCO uses a process known as case management. The following statements describe individuals who are Poplar plan members: -Brad Van Note, age 28, is taking many different, costly medications for
Mr. Van Note, Mr. Albrecht, and Ms. Cromartie
Mr. Van Note and Ms. Cromartie only
Mr. Van Note and Mr. Albrecht only
Mr. Albrecht and Ms. Cromartie only
Question 25
Ashley Martin is covered by a managed healthcare plan that specifies a $300 deductible and includes a 30% coinsurance provision for all healthcare obtained outside the plan’s network of providers. In 1998, Ms. Martin became ill while she was on vacation, was hospitalized, and incurred $2,000 for healthcare that she obtained outside her plan’s network, but that is covered by the plan. Ms. Martin incurred no other out-of-network expenses during 1998. Of the $2,000 in covered out-of-network expenses that Ms. Martin incurred, she is responsible for paying a total of: