AHIP AHM-250 問題集

質問 1：
In order to generate exchanges with consumers, healthcare plan marketers use the four elements of the marketing mix: product, price, place (distribution), and
A. plan design
B. segmentation
C. promotion
D. publicity
正解：C

質問 2：
One of the most influential pieces of legislation in the advancement of health plans within the United States was the Health Maintenance Organization (HMO) Act of 1973. One of the provisions of the Act was that it
A. established a process by which HMOs could obtain federal qualification
B. exempted HMOs from all state licensure requirements.
C. required all employers that offered healthcare coverage to their employees to offer only one type of federally qualified HMO.
D. eliminated funding that supported the planning and start-up phases of new HMOs.
正解：A

質問 3：
Health plans require utilization review for all services administered by its participating physicians.
A. False
B. True
正解：A

質問 4：
Which of the following statements about EPO & HMO models is FALSE?
A. Out-of-network visit is not allowed in HMO model.
B. In-network visit is allowed only on PCP's referral in HMO model.
C. In-network visit is allowed only on PCP's referral in EPO model.
D. Out-of-network visit is not allowed in EPO model.
正解：B

質問 5：
Which of the following statements about the Title VII of the Civil Rights Act is WRONG?
A. Allows HMOs to set different policies for people from different races, religions, sex or national origin to safeguard their interests.
B. Protects all employees
C. Pregnancy Discrimination Act (an amendment to this act) requires health plans to provide coverage during childbirth and related medical conditions on the same basis as they provide coverage for other medical conditions
D. Employers with more than 15 employees engaged in interstate commerce need to comply
正解：A

質問 6：
Katrina Lopez is a claims analyst for a health plan that provides a higher level of benefits for services received in-network than for services received out-of-network. Ms. Lopez reviewed a health claim for answers to the following questions:
Question A -
A. A, B, and D only
B. A and C only
C. B, C, and D only
D. A, B, C, and D
正解：D

質問 7：
Provider integration has two components: operational integration and structural integration. An example of operational integration in health plans is the:
A. Formation of an organization by a group of providers to carry out billing, collections, and contracting with health plans for the entire group of providers.
B. Acquisition of the Leopard Health Plan by the Hickory Health Plan.
C. Joint venture entered into by the Eclipse Health Plan and a local hospital system to create a new health plan in which Eclipse and the hospital system share ownership.
D. Consolidation of the Carver Health Plan and the Limestone Health Plan.
正解：A