AHIP Governance and Regulation - AHM-510 FREE EXAM DUMPS QUESTIONS & ANSWERS]

Question 1

The following statements are about market conduct examinations of health plans. Select the answer choice that contains the correct statement.

A. Once an examination report is provided to the state insurance department, a health plan is not given an opportunity to present a formal objection to the report. B. In imposing sanctions on health plans, state insurance departments are required to follow federal sentencing guidelines. C. Market conduct examinations of a health plan's advertising and sales materials include comparing the advertising materials to the policies they advertise. D. Multistate examinations are not appropriate for financial examinations, because regulatory requirements concerning a health plan's financial condition tend to vary from state to state.

Discussion 0

Correct Answer: C Vote an answer

Question 2

Health maintenance organizations (HMOs) seeking federal qualification under the HMO Act of 1973 and its amendments must meet requirements in four basic operational areas. One operational requirement for qualification is that an HMO must

A. Ensure that there is adequate representation of underserved communities on its policy-making body B. Have an ongoing quality assurance program that meets the requirements of the Centers for Medicaid & Medicare Services (CMS), stresses health outcomes, and provides for review by health professionals C. Ensure that at least 1/3 of its policy-making body is comprised of HMO members D. Test, safeguard, and promote quality of care by following detailed programmatic techniques that are explained in CMS's Federally Qualified HMO (FQHMO) Manual

Discussion 0

Correct Answer: B Vote an answer

Question 3

The following answer choices describe various approaches that a health plan can take to voice its opinions on legislation. Select the answer choice that best describes a health plan's use of grassroots lobbying.

A. A representative of the Palmer Health Plan is attending a one-on-one meeting with a legislator to present Palmer's position on pending managed care legislation. B. The Delancey Health Plan is launching a media campaign in an effort to persuade the public that proposed health care legislation will increase the cost of healthcare. C. The Bestway Health Plan is encouraging its employees to contribute to a political action committee (PAC) that is funding the political campaign of a pro-health plan candidate. D. The Stellar Health Plan is using direct mail and telephone calls to encourage people who support a patient rights bill to contact key legislators and voice their support for the bill.

Discussion 0

Correct Answer: D Vote an answer

Question 4

In 1994, the Department of Justice (DOJ) and the Federal Trade Commission (FTC) revised their 1993 healthcare-specific antitrust guidelines to include analytical principles relating to multiprovider networks. Under the new guidelines, the regulatory agencies will use the rule ofreason to analyze joint pricing activities by competitors in physician or multiprovider networks only if

A. All of the above B. The providers in a network share substantial financial risk C. The combining of providers into a joint venture enables the providers to offer a new product D. Provider integration under the network is likely to produce significant efficiencies that benefit consumers

Discussion 0

Correct Answer: D Vote an answer

Question 5

In the paragraph below, a statement contains two pairs of terms enclosed in parentheses. Determine which term in each pair correctly completes the statement. Then select the answer choice containing the two terms that you have chosen.
One type of acquisition is called a stock purchase. In a typical stock purchase, a company acquires (51% / 100%) of the voting shares of another company's stock, thereby making the acquired company a subsidiary. The (acquired / acquiring) company holds all of the assets and liabilities of the acquired company.

A. 100% / acquiring B. 51% / acquired C. 51% / acquiring D. 100% / acquired

Discussion 0

Correct Answer: D Vote an answer

Question 6

In the paragraph below, a statement contains two pairs of terms enclosed in parentheses.
Determine which term in each pair correctly completes the statement. Then select the answer choice containing the two terms that you have chosen.
Inflation plays a role in the health plan environment by influencing the prices of healthcare services, supplies, and coverage. During an inflationary period, consumers typically have (more / less) purchasing power because the prices of goods and services increase (more / less) quickly than income.

A. More / less B. Less / less C. Less / more D. More / more

Discussion 0

Correct Answer: C Vote an answer

Question 7

States may impose nominal deductibles, coinsurance, or copayments on some Medicaid recipients for certain services. Services for which states can require copayments from Medicaid recipients include:

A. Neither A nor B B. A only C. Family planning services D. B only E. Both A and B F. Emergency services

Discussion 0

Correct Answer: B Vote an answer

Question 8

Brighton Health Systems, Inc., a health plan, wants to modify its advertising and marketing materials to avoid liability risk under the principle of ostensible agency. One step that Brighton can take to reduce the likelihood of being liable for provider negligence under the theory of ostensible agency is to

A. Use advertising materials to characterize Brighton's role as providing physicians, hospitals, and other healthcare professionals rather than arranging for healthcare. B. Add disclaimers to advertising materials indicating that only physicians and not Brighton make medical decisions C. Use advertising materials which state that Brighton itself provides healthcare D. Guarantee the quality of medical care provided to Brighton members

Discussion 0

Correct Answer: B Vote an answer